Carotid–cavernous fistula secondary to carotid artery dissection in a patient with probable fibromuscular dysplasia: a case report
Year: 2026
Type: conference-abstract
Abstract: Case Presentation: A 43-year-old woman with a history of systemic arterial hypertension and solitary kidney after right nephrectomy in 2017 presented with pulsatile tinnitus on the left side, associated with proptosis, conjunctival chemosis, partial ptosis, and horizontal diplopia on left gaze. She had a previous history of vascular disease of unclear etiology with multiple arterial dissections and was receiving dual antiplatelet therapy. She had a recent intracranial dissection of the left internal carotid artery and was referred for urgent hospital admission due to progressive orbital symptoms. Neurological examination revealed an alert and oriented patient with preserved motor strength and coordination. Cranial nerve examination showed left abducens nerve palsy with diplopia on horizontal gaze, in addition to orbital congestion characterized by proptosis and conjunctival chemosis. Cerebral angiography confirmed a carotid–cavernous fistula. Previous vascular imaging demonstrated dissection of the intracranial segment of the left internal carotid artery with significant stenosis and intimal flap, ectasia of the contralateral carotid artery, and tortuosity of vertebral arteries with focal dilatation. Systemic vascular imaging revealed additional abnormalities including aneurysmal dilation of the celiac trunk and focal dissections of both common iliac arteries, suggesting an underlying systemic arteriopathy compatible with fibromuscular dysplasia. The patient underwent endovascular treatment with embolization of the fistula and angioplasty of the left internal carotid artery with placement of a flow-diverting stent. After the procedure, there was marked improvement of pulsatile tinnitus, proptosis, and ocular hyperemia. Diplopia gradually improved during hospitalization. The patient remained clinically stable under dual antiplatelet therapy. Discussion: Carotid–cavernous fistula is an abnormal communication between the carotid arterial system and the cavernous sinus, resulting in venous hypertension and orbital congestion. Spontaneous fistulas are uncommon and may be associated with conditions that weaken the arterial wall, including fibromuscular dysplasia. This non- atherosclerotic arteriopathy is characterized by arterial stenosis, aneurysm formation, dissections, and vascular tortuosity affecting multiple vascular territories. In this case, the presence of multiple dissections, aneurysmal dilatations, and diffuse vascular irregularities strongly suggested an underlying systemic arteriopathy. Endovascular treatment represents the preferred therapeutic approach and may provide rapid symptom relief while preserving arterial patency. Final Comments: This report describes a rare presentation of carotid–cavernous fistula secondary to carotid artery dissection in a patient with probable fibromuscular dysplasia and multisite vascular involvement. Recognition of characteristic orbital symptoms is essential for early diagnosis, and prompt endovascular treatment can lead to favorable clinical outcomes.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7225040554