Carotid occlusion for the management of a spontaneous carotid-cavernous fistula occurring in a single functional internal carotid artery

Carotid-cavernous fistula (CCF) is an abnormal communication between the main trunk of carotid artery or its branches and the cavernous sinus. Most of the cases of CCF occur following head trauma, but congenital and spontaneous cases have been reported. We report the case of a 47-year-old patient, who initially consulted (in 2012) for headache, tinnitus and diplopia on the left side, without history of trauma, for 1 month before his consultation. An angio-MRI was performed revealed a bilateral carotid-cavernous fistula, then an arteriography for therapeutic purposes with occlusion by coils of the left intracavernous internal carotid artery, arterial replacement being provided by the right internal carotid. 10 years later, the patient consulted for an increase in headaches with the appearance of exophthalmos and diplopia on the right side, a control diagnostic arteriography was performed, and a decision to occlude the right intracavernous internal carotid artery (which is the single functional internal carotid artery) was retained and successfully performed.