Carotid-cavernous fistulas

Abstract Carotid-cavernous fistulas (CCFs) are pathologic shunts between the carotid artery and the cavernous sinus. CCFs can be grouped into one of two anatomical categories, direct and indirect, on the basis of their angioarchitecture. Although CCFs have historically been difficult to treat, they are now routinely managed with low associated rates of morbidity and mortality. Endovascular treatment using both transarterial and transvenous access routes, with a goal of complete fistula occlusion and preservation of normal blood flow through the internal carotid artery, has emerged as the primary treatment modality. Meticulous inspection of the anatomy and angioarchitecture is essential, and a tailored, patient-specific approach should be taken for each CCF. Because of improvement in endovascular technologies and techniques, endovascular treatment strategies are now available for even the most complex fistulas.