OCCLUSION OF LEFT DIRECT CAROTID CAVERNOUS FISTULA
David Kumpe, M.D. and Daniel Huddle, M.D.

INSTITUTION: University Of Colorado Hospital, Denver, Colorado

DESCRIPTION OF PROCEDURE: Occlusion of left direct carotid cavernous fistula

DATE OF PROCEDURE: November 7, 2001

PRESENTING SYMPTOMS: 45 year-old female with deteriorating vision in the left eye.

PATIENT HISTORY:
Patient had auto accident with head trauma. She had double vision after the MVA. 6 weeks after the MVA she noted proptosis and a red eye. A bruit was heard.

A direct carotid cavernous fistula was diagnosed by angiography at an outside hospital. At that time there was filling of the superior and inferior ophthalmic veins, without any filling of cortical veins. Coiling was attempted at the time of the angiogram, but could not be accomplished because the fistula site could not be catheterized from the arterial side.

DESCRIPTION OF PROCEDURE:
Repeat L internal carotid arteriography shows the retrograde filling of the SOV and IOV. In addition, there is now flow into the vein of Labbe and shunting into the transverse-sigmoid sinus junction via the vein of Labbe.

A 6F Envoy guide catheter was placed into the LICA. A SYNCHRO™ Neuro Guide Wire (0.014") from Precision Vascular was passed through the fistula point with some delay because of the small size of the fistula. A Prowler 14 microcatheter was passed into the cavernous sinus, and the left cavernous sinus filled with GDCs.

CLINICAL OUTCOME:
By the next day the proptosis and red eye were gone. The patient was very happy with the result.

OBSERVATIONS ON GUIDE WIRE PERFORMANCE:
Excellent torque control in the sharp bend of the ICA where the fistula point lay. It is easy to see why the previous attempt to pass a wire through the fistula point had failed. I am not sure any other wire would have had the combination of torque control with the appropriate softness of the wire tip.

The wire was inserted a total of six times, and never became deformed or lost performance in spite of highly tortuous vasculature. When I straightened the tip to facilitate safe removal of the microcatheter at the end of the case, it did not take on a spiral shape as other wires usually do.

LIST OF DEVICES USED:
6F Envoy® Guide Catheter (Cordis Endovascular)
Prowler® 14 Microcatheter (Cordis Endovascular)
SYNCHRO™ Neuro Guide Wire, Model 1301 (Precision Vascular)

WLT0105/A