Article Figures & Data
Figures
- Fig 1.
Images in a 49-year-old man with a left TCCF and a TCA of the supraclinoid ICA.
A, Left frontal carotid angiogram shows a TCCF with moderate steal phenomenon. The aneurysm was overlooked because of its small size and masking by a nearby parent artery and its venous drains.
B, A detachable balloon was placed into the CS with subtotal occlusion of the TCCF. A small TCA about 3 × 2 mm was found at the left supraclinoid ICA (arrow).
C, Occlusion of the TCA was achieved by the use of a Guglielmi detachable coil (GDC). Because of the progressive, increased residual fistula flow, the residual TCCF was subsequently obliterated by using GDCs and liquid adhesive, with preservation of the ICA.
- Fig 2.
Images in a 40-year-old man with a TCCF and a TCA of the left supraclinoid ICA.
A, Left lateral carotid angiogram reveals a TCCF with complete steal phenomenon and no opacification of the supraclinoid ICA or TCA.
B, The TCCF was occluded by a detached balloon. A small TCA at the supraclinoid ICA (arrow) was demonstrated and subtotally obliterated with GDCs.
C, The patient had a recurrent TCCF due to puncture of the detached balloon; this was eventually occluded by using a detachable balloon, GDCs, and liquid adhesive, with preservation of the ICA.
- Fig 3.
Images in a 29-year-old man with a left TCCF and a TCA of the supraclinoid ICA.
A, Endovascular occlusion of the TCCF was attempted 3 weeks after trauma. Right lateral postembolization angiogram shows partial occlusion of right TCCF. There is no evidence of the TCA at the supraclinoid ICA because of its latent period.
B, Second embolization was performed 2 weeks after the first attempt. A small TCA was initially ignored (arrow) and found after subtotal occlusion of the residual TCCF. However, fatal rupture occurred before an attempt to treat the TCA was made.
- Fig 4.
Images in a 19-year-old man with left paraophthalmic aneurysm associated with a TCCF.
A, Left carotid angiogram reveals a paraophthalmic TCA (arrow) with rupture into a giant CS varix and draining to the superior ophthalmic vein and inferior petrosal sinus.
B, The TCA was subtotally occluded by using GDCs, which also resulted in complete occlusion of the TCCF.
Tables
Demographic and clinical outcomes in patients with TCAs associated with TCCFs
Patient/Sex/Age, (y) Clinical Manifestations on Endovascular Treatment Initial CT Findings Location and Size of the TCA of the ICA TCA Detection Prior to TCCF Occlusion Steal of TCCF Trauma to Embolization, wk Outcome Follow-Up, mo 1/M/49 Chemosis, proptosis, diplopia Subarachnoid hemorrhage, facial bone fracture Supraclinoid, 3 × 2 mm No Moderate 8 Occlusion of TCCF and TCA with ICA preservation 25 2/M/40 Chemosis, proptosis, decreased visual acuity Brain swelling, facial bone fracture Supraclinoid, 3 × 3 mm No Complete 15 Occlusion of TCCF and TCA with ICA preservation 24 3/M/29 Chemosis, proptosis, decreased visual acuity Subarachnoid and intracerebral hemorrhages, facial bone fracture Supraclinoid, 3 × 3 mm No Moderate 3 and 5 Subtotal occlusion of TCCF, fatal rupture of the TCA 0.25 4/M/18 Chemosis, proptosis, decreased visual acuity, bruit Intracerebral hemorrhage Paraophthalmic, 5 × 4 mm Yes Occlusion of the supraclinoid ICA 13 Occlusion of TCA and TCCF 12
