Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2023; 11(25): 6005-6011
Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.6005
Carotid-cavernous fistula following mechanical thrombectomy of the tortuous internal carotid artery: A case report
Lin-Zhuo Qu, Guang-Hui Dong, En-Bo Zhu, Ming-Quan Lin, Guang-Lin Liu, Hong-Jian Guan
Lin-Zhuo Qu, Department of Medicine, Yanbian University, Yanji 133000, Jilin Province, China
Guang-Hui Dong, En-Bo Zhu, Ming-Quan Lin, Guang-Lin Liu, Hong-Jian Guan, Department of Neurology, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin Province, China
Author contributions: Qu LZ followed up with the patient and wrote the paper; Zhu EB participated in the treatment and management of the patient; Lin MQ and Liu GL collected the data; Dong GH helped to correct the article; Guan HJ conceptualized the idea and finalized the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Jian Guan, MD, Chief Doctor, Professor, Department of Neurology, Affiliated Hospital of Yanbian University, No. 1327 Juzi Street, Yanji 133000, Jilin Province, China. hjguan@ybu.edu.cn
Received: July 4, 2023
Peer-review started: July 4, 2023
First decision: July 18, 2023
Revised: July 26, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: September 6, 2023
Processing time: 59 Days and 6.8 Hours
Abstract
BACKGROUND

A carotid-cavernous fistula (CCF) is an abnormal connection between the internal carotid artery (ICA) and the cavernous sinus. Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures, they can occur as surgery-related complications after mechanical thrombectomy (MT). With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion, it is important to document CCF following MT and how to avoid them. In this study, we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.

CASE SUMMARY

A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h. The neurological examination revealed left central facial paralysis and left hemiplegia, with a National Institutes of Health Stroke Scale score of 9. Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown. Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery. Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA. We performed suction combined with stent thrombectomy. Then, postoperative angiography was performed, which showed a right CCF. One month later, CCF embolization was performed, and the patient’s clinical symptoms have significantly improved 5 mo after the operation.

CONCLUSION

Although a CCF is a rare complication after MT, it should be considered. Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.

Keywords: Carotid-cavernous fistula; Complication; Mechanical thrombectomy; Internal carotid artery; Tortuosity; Case report

Core Tip: The occurrence of carotid-cavernous fistula (CCF) after mechanical thrombectomy (MT) is rare, with only five cases reported in PubMed. Herein we report a rare case of CCF occurring after MT in a patient with acute ischemic stroke. This paper describes the tortuosity of the cavernous internal carotid artery (ICA). We believe that future analysis of ICA tortuosity will help evaluate the complexity of the surgery and better predict and avoid CCF and other complications.