Neurointervention.  2024 Jul;19(2):106-110. 10.5469/neuroint.2024.00213.

Successful Embolization of a Direct Carotid Cavernous Fistula under Gadolinium-Based Angiography

• Li YL
• Rai S
• Cox PJ

• KMID: 2556662
• DOI: http://doi.org/10.5469/neuroint.2024.00213

Abstract

Endovascular neurointervention is typically performed with iodinated contrast medium (ICM) under fluoroscopy. However, some patients may be contraindicated to such procedures based on their sensitivity to ICM. In this report, we describe a case of successful coil embolization of a direct carotid cavernous fistula using angiography with gadolinium-based contrast agents in a patient with severe allergic reaction to ICM. The clinical decision-making for this patient was further complicated by comorbidities of renal impairment, drug allergies, and previously severe gastrointestinal bleeding.

Keyword

Gadolinium; Carotid cavernous fistula; Aneurysm

Figure

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  Fig. 1. Magnetic resonance angiography (MRA) axial images showing previously unruptured right cavernous internal carotid artery aneurysm 6 years prior in time-of-flight sequence (A), evidence of rupture into the cavernous sinus in the present admission in time-resolved imaging of contrast kinetics sequence (B), and complete occlusion on control MRA in 6 months post embolization (C). Image quality of gadolinium enhanced digital subtraction angiography images in lateral projection on pre-procedural (D) and post-coiling injections (E). Image quality of gadolinium enhanced three-dimensional rotational (F) and axial reformatted (G) images in cone-beam computed tomography acquisition used for working projection curation and procedure planning.

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