RT Journal Article
SR Electronic
T1 A novel approach to the treatment of a direct carotid–cavernous fistula in a patient with Ehlers–Danlos syndrome type IV
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr2014011414
DO 10.1136/bcr-2014-011414
VO 2014
A1 Nakagawa, Ichiro
A1 Park, Hun Soo
A1 Wada, Takeshi
A1 Takayama, Katsutoshi
A1 Nakagawa, Hiroyuki
A1 Kichikawa, Kimihiko
A1 Nakase, Hiroyuki
YR 2014
UL http://casereports.bmj.com/content/2014/bcr-2014-011414.abstract
AB We report a case of a direct carotid–cavernous fistula (CCF) in a patient with Ehlers–Danlos syndrome type IV who presented with progressive chemosis and diplopia. To prevent potential lethal arterial wall injury due to the fragility of the arterial vessel wall, the ipsilateral carotid artery and internal jugular vein were surgically exposed for direct insertion of endovascular sheaths, and transvenous embolization was performed using triple microcatheters with detachable coils. The clinical course was uneventful, and chemosis and diplopia subsequently resolved. By the 6 month follow-up, MRI revealed no recurrence of the CCF. These techniques offer a unique access alternative for endovascular treatment, thereby reducing the risks associated with arterial dissection that often accompanies transfemoral access in this particular condition.