Publication date: Available online 6 November 2015 Source:Journal of Clinical Neuroscience Author(s): Kiyoshi Tsuji, Nobuhiro Nakagawa, Norihito Fukawa, Kazuhiro Nagatsuka, Naoki Nakano, Amami Kato The fistulous point in a direct carotid-cavernous fistula (CCF) can often be difficult to identify because of high-flow shunting. A novel technique that is useful for identifying the fistulous point is reported. A 71-year-old woman underwent endovascular therapy for a left direct CCF that presented with sudden diplopia and tinnitus. To identify the fistulous point, vertebral angiography with manual compression of the left carotid artery was attempted, as was slow injection of a contrast agent from a balloon guiding catheter, closing off the left internal carotid artery; however, the shun…
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