Question

Discuss role of parent artery occlusion in the treatment of carotico-cavernous fistulae.

Hint:

Parent artery occlusion is highly effective in treating direct CCFs but must be done with caution to avoid ischemic complications.

Answer 1

Parent artery occlusion is an important treatment option for carotico-cavernous fistulae (CCF), particularly in cases of direct CCFs.
Step 1: Indications for Parent Artery Occlusion:
Parent artery occlusion is indicated when endovascular embolization is not feasible or effective. It involves occluding the parent artery supplying the fistula, typically the internal carotid artery, to stop blood flow into the abnormal fistula. This can be done through embolization or surgical ligation.
Step 2: Mechanism of Action:
Occlusion of the parent artery causes the fistula to thrombose by eliminating the blood supply to the cavernous sinus. This leads to a reduction in the high blood flow seen in direct CCFs, which can alleviate symptoms and prevent further complications.
Step 3: Risks and Considerations:
1. Stroke Risk: There is a risk of stroke if collateral circulation is inadequate.
2. Delayed Complications: Although effective, the procedure can sometimes result in delayed complications such as cranial nerve deficits or ischemic complications.