Bilateral Post-Traumatic Carotid-Cavernous Fistula: A Case Report

Background and Clinical Significance: Carotid-cavernous fistulas (CCFs) are pathological communications between the carotid artery and the cavernous sinus, most commonly traumatic when direct and high-flow (Barrow type A). Bilateral traumatic CCFs are rare, occurring in approximately 1-2% of cases. Case Presentation: We report a 45-year-old male with polytrauma after a road traffic accident who presented with right-sided chemosis, pulsatile exophthalmos, and ocular bruit. Digital subtraction angiography revealed bilateral direct CCFs. The right fistula was treated with transarterial coil embolization combined with flow-diverter stent placement in the intracavernous internal carotid artery. Subsequent imaging demonstrated left-hemispheric ischemia while the contralateral high-flow CCF remained untreated; the underlying mechanism was considered potentially hemodynamic or thromboembolic. The left fistula was managed using the same technique. Final angiography confirmed complete bilateral occlusion. Despite transient postoperative epistaxis, the patient showed neurological improvement. Conclusions: This case highlights the effectiveness of combined flow diversion and coiling in managing rare bilateral traumatic CCFs.