title: Radial Artery Graft Bypass with Endovascular Trapping of the Internal Carotid Artery for Recurrent Carotid Cavernous Fistula: Different Surgical Fields, Different Surgical Considerations.
abstract: BACKGROUND
  Venous infarction in the brainstem caused by venous congestion is an extremely rare complication of traumatic carotid cavernous fistulas (CCFs). This condition requires immediate treatment and a multimodal treatment strategy is needed to prevent recurrence.
  
  
  METHODS
  A 24-year-old man presented with exophthalmos and chemosis after a bicycle accident. Cerebral angiography showed an engorged right superior ophthalmic vein and a right carotid cavernous fistula. Transvenous coil embolization was successfully performed without severe complications. Two months later, a decline in mental status occurred. Follow-up angiography showed recanalization of the CCF. The patient underwent radial artery graft bypass surgery combined with endovascular trapping of the internal carotid artery. Sylvian veins and other cortical veins became intraoperatively arterialized and we observed marked brain edema after high-flow CCF. After surgery, the patient's mental status recovered and angiography showed good patency of the bypass graft and complete obliteration of the recurrent CCF.
  
  
  CONCLUSIONS
  To ensure prevention of recurrent CCF, internal carotid artery trapping combined with high-flow bypass surgery can be a good salvage treatment for urgent cases in which an endovascular approach already failed.
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Jiwook
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sehun
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea. Electronic address: nscsk@hanmail.net.
authors.forename: Seok Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Yeongu
authors.initials: Y
authors.lastname: Chung
mesh_terms: D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D017534:Radial Artery / Q000637:transplantation*; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: High-flow bypass; Traumatic carotid cavernous fistula; Venous infarction