Endovascular Treatment of Direct Internal Carotid Artery-Internal Jugular Vein Fistula

To present the case of a 30 year old woman admmited to Emergency Medical Services because of sudden neurological deterioration. Initial NCCT showed no intracranial hemorrage but a giant mass in the neck. AngioCT was performed and revealed probable ruptured extracranial ICA aneurysm. Angiogram showed direct extracranial ICA (internal carotid artery)‐ IJV (internal jugular vein) fistula with a giant aneurysm and also ECA (external carotid artery) ‐ intracranial veins fistula with engorgement. Endovascular two steps approach was done. Initially “full metal jacket" stenting was done in ICA with cardiologic coated scaffolded stents to cover ICA wide neck aneurysm. “Cooker´s pressure technique" was done to stop arterial aneurysm blood inflow into engorged yugular vein. intrasacular microcatheter was placed trough stents stroots, a second microcatheher was navigated from the contralateral jugular vein until the foot of fistula; coils were deployed covering all stent surface and filling anuerysm sac while cohesive injection was done from vein, droping of blood pressure was performed for a few minutes. Second step was done through “in foot" ECA‐ intracranial veins embolization with coils and cohesive. Patient was admitted to ICU, neck heamatoma was drained and two weeks later patient was discharged with only very mild disphasia.