The Methods of Reserving Integrity of Seriously Damaged Cavernous Carotid in the Management of Traumatic Carotid-Cavernous Fistula

Background: The A type of carotid-cavernous fistulas (CCF-A) is characterized by direct communication between the internal carotid artery (ICA) with a very low incidence. But it severely endangers the health and even the life of patients, not only causes insufferable symptoms but also can induce fatal epistaxis, intracranial hemorrhages or even death. So, this disease needs therapy as early as possible. The ideal treatment for CCF-A is to exclude the fistula from circulation, preserving the carotid flow. Interventional therapy has become the chief method for CCF-A especially in recent years, but the prerequisite, that the microwire or and microcatheter in ICA can be navigated across the orificium fistulae and into distal ICA, is necessary. Otherwise it is difficult to reserve the communication of seriously injured ICA and the orificium fistulae could simultaneously be reliably closed. The authors used a series of new and novel CCF with good result. Methods: The authors experienced a patient of TCCF-A, whose ICA was seriously injured and customary method failed in the first treatment because the microwire and microcatheter could not cross the segment of orificium fistulae. Then, the authors applied military (outflanking techniques, aerial refueling, and retrograde navigation) to manage this case. Results: Finally, the CCF-A was completely cured and the parent artery was perfect preserved without any complication. Conclusions: For patients of TCCF-A with severe ICA injury, these strategies may be very important for some patients whose affected ICA cannot tolerant to be blocked.