Endovascular electrothrombosis treatment for carotid cavernous fistula caused by ruptured primitive trigeminal artery aneurysm: a case report and literature review

Abstract Background and Importance: Persistent primitive trigeminal artery aneurysms are clinically rare, especially with carotid cavernous fistula caused by their rupture. At present, endovascular treatment is of choice for carotid cavernous fistula, including by detachable balloon / coil, coil combined with Onyx glue, covered stent and so on. We cured a patient harbored carotid cavernous fistula caused by a ruptured primitive trigeminal artery aneurysm by detachable coil combined with endovascular electrothrombosis with a good result. Clinical Presentation: The patient was admitted with a history of head trauma over two months ago and had experienced right eye protrusion for the past three weeks. Physical examination revealed protrusion of the right eye, along with conjunctival congestion and swelling. Digital subtraction angiography (DSA) confirmed a diagnosis of an incomplete Cavernous Carotid Fistula (CCF) on the right side, associated with a Persistent Primitive Trigeminal Artery (PPTA) on the same side. We cured by a ruptured primitive trigeminal artery aneurysm by detachable coil combined with endovascular electrothrombosis with a good result. It effectively avoided the mass effect associated with excessive coil filling and mitigated the risk of unintended embolization. Conclusion: The combination of mechanical detachable bare metal coil embolization and electrocoagulation presents a novel and innovative approach for addressing CCF resulting from a ruptured PPTA aneurysm. This approach brings several notable advantages, including cost-effectiveness, reduced mass effect from embolic materials, and avoidance of potential complications associated with the use of medical glue for embolization.