Transarterial Treatment of Traumatic Carotid Cavernous Sinus Fistula with Carotid Artery Dissection and Ruptured Pseudoaneurysm Using Flow Diverter and Detachable Coils

Direct carotid cavernous sinus fistula is a common delayed complication of head trauma, particularly in patients with skull base fractures. When carotid cavernous sinus fistula occurs together with carotid artery dissection, it poses a big challenge regarding successful treatment. Endovascular treatment options include occlusion with detachable balloons, coils, and Pipeline flow diverters (Chestnut Medical Technologies, Menlo Park [CA], USA). Here we describe the successful management of a patient with dual pathology with traumatic carotid cavernous sinus fistula and internal carotid artery dissection with multiple pseudoaneurysms using flow diverters and detachable coils.