Carotico -Cavernous Fistula can be defined as an abnormal communication between the carotid artery and cavernous sinus. Most patients with this condition experience progressive eye complications if the fistula is left untreated. Increasing Proptosis, Conjunctival Chemosis, and visual loss occur over months to years, with central retinal vein occlusion and secondary glaucoma representing the most severe ocular complications.
Endovascular management has become the primary treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique. This advantage along with the advancement in the field has led to fewer complications with higher success rate.
High flow fistulas (Barrow type A ) are usually post traumatic and are relatively easy to diagnose and identify due to their typical clinical presentation. However low flow spontaneous fistulas (Barrow types B, C, D) are of indirect type, develop typically in middle-aged women, with subtle clinical symptoms and signs. These patients are at 30% risk of developing visual loss due to increased intraocular pressure, ischemic optic neuropathy, retinal vessel occlusion, and/or even proliferative retinopathy followed by tractional retinal detachment. Common presentation is red eye with proptosis (often pulsatile) with or without tinnitus. The mainstay of treatment for CCF is endovascular therapy. This may be transarterial (mostly in the case of direct CCF) or transvenous (most commonly in indirect CCF). CCF may be treated by occlusion of the affected cavernous sinus (coils, balloon, liquid agents), or by reconstruction of the damaged internal carotid artery (stent, coils or liquid agents).