Treatment of recurrent carotid cavernous fistula by direct puncture of a previously trapped internal carotid artery.

Treatment of direct carotid cavernous fistulas has evolved from surgical ligation and trapping to endovascular techniques. Endovascular therapy allows occlusion of the fistula while preserving the parent carotid artery. The present report describes a case of direct carotid cavernous fistula that was initially treated with the trapping procedure 21 years earlier. The patient had a recurrent direct carotid cavernous fistula and was treated successfully with embolization by means of direct percutaneous puncture of the carotid artery above the trapped level. Direct puncture of the carotid artery is an alternative treatment in patients who lack safe access for direct carotid cavernous fistula embolization.