Trans-radial artery graft bypass embolization for traumatic carotid-cavernous fistula: case report

Objective: We report a case of traumatic carotid-cavernous fistula treated with a combination of endovascular therapy and direct surgery. Case presentation: A 24-year-old man presented with blurred vision and diplopia 6 years after a traffic accident. Cerebral angiography revealed a right carotid cavernous fistula with dilated cavernous sinus. After initial transarterial embolization of the cavernous sinus and internal carotid artery, a residual shunt was detected at the distal end of the coil mass. To reduce hemodynamic stress in the sacrificed internal carotid artery, we performed extracranial-intracranial high-flow bypass using a radial artery graft, and direct trapping of the internal carotid artery between the cervical bifurcation and the immediately proximal portion of the ophthalmic artery. However, a residual shunt from the distal end of the clip remained. Coil embolization of the fistula via radial artery graft occluded the residual shunt completely. Conclusion: Endovascular treatment via radial artery graft is a safe and valuable alternative when the primary access route is eliminated.