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E3105. Carotid-Cavernous Fistulas: Anatomic and Imaging Review

Daruwalla V,  Gunduru M,  Abdelhadi S,  Raval K,  Zuk C. Wayne State University/Detroit Medical Center, Detroit, MI

Address correspondence to V. Daruwalla (

Background Information: A carotid-cavernous fistula (CCF) is an abnormal vascular shunt between the carotid artery (or its branches) and the cavernous sinus. Anatomic, hemodynamic and etiologic (traumatic versus nontraumatic) variations have different clinical and radiographic presentations. The purpose of educational exhibit is to review the normal anatomy and physiology of the CCF and highlight the various radiologic studies used to evaluate this pathology with associated imaging findings.

Educational Goals/Teaching Points: This exhibit will review the anatomy and physiology for the carotid artery and the cavernous sinus and include understanding various classifications of CCF such as anatomic classification (direct vs indirect), Barrow classification (type A–D, high flow versus low flow), etiologic types (traumatic versus atraumatic collagen deficiency syndromes). Participants will understand various imaging modalities such as CT, MRI, MR angiography and conventional angiography available for evaluating CCF and their related findings. Various complications of CCF such as watershed infarcts, basal ganglia hemorrhages, and extensive flow in retroorbital venous structures are discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We describe the imaging findings of various CCF presentations and complications on multiple imaging modalities.

Conclusion: Carotid cavernous fistulas present a serious threat to a patient’s vision and may be life threatening. Therefore, these must be dealt with promptly. It is important for radiologists to identify CCFs and their complications on various imaging modalities and alert referring physicians so they may proceed with appropriate management for the patient.