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Papers of the Week

2019 Oct

No Shinkei Geka



[Internal Carotid Artery-Cavernous Sinus Fistula in a Patient with Masked Hypertension Caused by Bilateral Subclavian Artery Stenosis:A Case Report].


Shimozato R, Hayashi M, Hidaka Y, Takezawa H, Iijima A
No Shinkei Geka. 2019 Oct; 47(10):1065-1072.
PMID: 31666423.


We herein report a case of direct carotid-cavernous fistula(direct CCF)in a patient with masked hypertension caused by bilateral subclavian artery stenosis. A 74-year-old woman presented with headache, right-sided proptosis, double vision, and pulsatile tinnitus since past 10 days. The patient was diagnosed with direct CCF. Transarterial embolization in the region of the right internal carotid artery was performed, after which her symptoms resolved. However, additional interventions in the form of subclavian artery stenting were required, because of the complications of left subclavian artery occlusion and right subclavian artery stenosis. Satisfactory dilatations were achieved, and the angiographic 'steal' phenomenon disappeared. The patient had terminated antihypertensive treatment because of the normalization of her brachial blood pressure; however, this was merely pseudo-normalization due to subclavian artery insufficiency. We consider this a case of direct CCF occurring as a complication of masked hypertension caused by bilateral subclavian artery stenosis.