Abstract 447: Transverse Facial Vein Approach For Complex Primary Coil Embolization of Barrow Type‐D Carotid‐Cavernous Fistula

Carotid‐Cavernous fistulas (CC fistula) are aberrant connections between the carotid arterial system and the cavernous sinus (CS). The result is an abnormal arteriovenous shunt which can have a range of symptomatology based on involvement of neighboring neural and vascular structures within the CS. Clinically, patients can present with Dandy's triad of exophthalmos, bruit and chemosis, but often present insidiously with diplopia/visual disturbance, orbital pain or cranial nerve deficits. While cross‐sectional imaging bears high diagnostic value, cerebral angiography remains the gold‐standard for the characterization of CC fistulas. We describe a case of a Barrow Type‐D indirect CC fistula, treated endovascularly with transfacial venous approach and retrograde coil embolization of the right greater than left CS.