Carotid-cavernous fistula following mechanical thrombectomy of the tortuous internal carotid artery: A case report

Figure 1 Image of an intracranial major artery embolism. A and B: Magnetic resonance angiography and computed tomography angiography showing occlusion of the right internal carotid artery and middle cerebral artery (ellipses), respectively.

Figure 2 Angiography before thrombectomy. A and B: Digital subtraction angiography showing an occlusion beyond the origin of the right internal carotid artery (arrows); C: The A1 segment of the right anterior cerebral artery was blocked, and there was no compensatory blood flow to the right middle cerebral artery (ellipse).

Figure 3 Thrombectomy and carotid-cavernous fistula formation. A: After the aspiration thrombectomy, the digital subtraction angiography showed occlusion of the terminal bifurcation of the right internal carotid artery (arrow); B: After the first stent removal, angiography showed poor right middle cerebral artery (MCA) reflow and no carotid-cavernous fistula (CCF) (arrow); C and D: After a second stent thrombectomy, reexamination showed CCF (arrows); E: Reflow of the A1 segment of the right anterior cerebral artery to supply blood to the right MCA supply area (circle).

Figure 4 Cavernous internal carotid artery tortuosity. The acute angle of the anterior genu = 37.119°, the posterior genu angle = 56.618°.

Figure 5 Comparison of the physical characteristics of the patient before and after carotid-cavernous fistula embolization. A and B: Physical examination on admission: Right proptosis, ptosis and limited eye movement; C and D: After five months of follow-up, the symptoms were relieved.