A case of indirect carotid cavernous fistula presenting with proptosis and pulsatile exophthalmos

Carotid cavernous fistulas (CCF) are abnormal arteriovenous anastomoses between the internal carotid artery (ICA) and the cavernous sinus (CS). There are two broad categories of CCFs with different clinical presentations in direct and indirect form. Internal carotid artery and the CS in the "direct" or "high flow" CCF, and branches of the internal and external carotid artery in "indirect" or "low flow" CCF are found abnormally connected. In the present case, a CCF draining into the ophthalmic vein was detected between the ICA and the CSs. An endovascular flow diverter stent was inserted, and the fistula line was closed. The complaints of the patient immediately disappeared. In CCFs, the flowing stent can completely close the fistula line in a selected patient and appropriate localization. Keywords: Flow diverter stent, carotid cavernous fistula, CCF superior ophthalmic vein