Home-Based Therapy Utilizing Intermittent Manual Compression of the Carotid Artery and Internal Jugular Vein in the Management of Carotid-Cavernous Fistula

A carotid-cavernous fistula (CCF) is an abnormal communication between the carotid artery and the cavernous sinus, which can be of a direct or indirect type. Treatment decisions are based on factors such as the type of CCF, angioarchitecture, severity of clinical symptoms, and risk of vision loss. While most fistulas necessitate endovascular intervention, there are isolated reports of indirect low-flow fistulas resolving with manual vascular compression therapy alone. Herein, we present the case of a 66-year-old female patient who presented with features of indirect CCF exhibiting intermittent headache, orbital swelling, proptosis, and conjunctival chemosis of the right eye, successfully treated with intermittent manual vascular compression therapy, resulting in the complete occlusion of the fistula and the resolution of her ocular symptoms. This case suggests that manual intermittent vascular compression therapy may be a viable non-invasive treatment option for patients with low-flow indirect CCF, potentially obviating the need for early endovascular procedures.