Unilateral Venous Approach to Contralateral or Bilateral Carotid Cavernous Shunts

Area of Science:

• Vascular Surgery
• Interventional Neuroradiology
• Neuroscience

Background:

• Cavernous carotid fistulas (CCF) are complex vascular lesions.
• Venous approach treatment depends on venous drainage pathway patency.
• Unilateral approaches to bilateral shunts are challenging.

Purpose of the Study:

• To present experience with a unilateral across-the-midline venous approach for treating bilateral and unilateral carotid cavernous shunts.
• To achieve anatomic cure by targeting specific anatomic compartments.

Main Methods:

• Utilized a transarterial guiding catheter for angiography and road mapping.
• Employed a venous triaxial system for distal navigation across the midline via the coronary sinus.
• Favored coil embolization, supplemented with liquid embolic agents when necessary.

Main Results:

• Achieved complete occlusion in five patients during a single session.
• One patient required additional transarterial embolization.
• All patients demonstrated complete angiographic cure with persistent occlusion on follow-up imaging, with no complications.

Conclusions:

• Meticulous assessment of venous anatomy and fistulization is crucial for treating CCF.
• The contralateral venous route is a safe and viable option when visualized.
• Crossing the midline via the coronary sinuses is an effective strategy for CCF treatment.