ROMANIAN JOURNAL OF NEUROLOGY – VOLUME XVII, NO. 4, 2018 191 POSTTRAUMATIC CAROTID-CAVERNOUS FISTULA – AN ENDOVASCULAR CAROTID STENT-GRAFT APPROACH Ionut Flavius Bratu 1 , Athena Cristina Ribigan 1,2 , Bogdan Dorobat 3 , Vlad Eugen Tiu 2 , Bogdan Casaru 2 , Ovidiu-Alexandru Bajenaru 1,2 , Florina Anca Antochi 2 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest 2 Department of Neurology, Emergency University Hospital, Bucharest 3 Department of Interventional Neuro-Radiology, Emergency University Hospital, Bucharest ABSTRACT Objectives. The carotid-cavernous fistula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year old male patient with medical history of subarachnoid hemorrhage and cranio-fa- cial comminuted fractures due to a motorcycle accident-induced craniofacial traumatism (4 months prior to admis- sion) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital substraction angiography showed a direct CCF type A. The Neurology and Intervention- al Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effective procedure in selected cases of CCF. Keywords: carotid-cavernous fistula, endovascular, stent-graft Author for correspondence: Ionut Flavius Bratu, Dr. Thoma Ionescu 6, Apt. 2, 050573, Sector 5, Bucharest, Romania E-mail: flavius.bratu@yahoo.com CASE REPORTS Abbreviations list: CCF(s) = carotid-cavernous fistula(e); CS = cavernous sinus; ICA = internal carotid artery; ECA = external carotid artery; CT = computed tomography; F = French. INTRODUCTION The carotid-cavernous fistula represents an ab- normal arterio-venous communication developed between the internal and/or the external carotid ar- tery or their branches and the cavernous sinus. The most widely used criteria for the classification of CCFs are: anatomy (angiographical criterion), etio- pathogenesis and blood flow (1). Based on the anatomical-angiographical criteri- on, according to Barrow and Tomsick, the CCFs can be classified as direct (intracavernous segment of the ICA and CS direct connection) and indirect or dural (communication via branches of ICA and/ or ECA). Furthermore, the classification involves five types: type A (direct connection between the intracavernous segment of the ICA and the CS), type B (dural communications between intracav- ernous branches of the ICA and the CS), type C (dural communications between meningeal branch- es of the ECA and the CS) and type D (dural com- munications between the intracavernous branches of the ICA, meningeal branches of the ECA and the CS) with the subtypes D1 and D2 based on the ar- terial supply being unilateral or bilateral (2,3). As for their etiopathogenesis, the CCFs can be divided into posttraumatic, which account for 70- 90% of the CCF cases and other etiologies, includ- ing spontaneous (4). Ref: Ro J Neurol. 2018;17(4) DOI: 10.37897/RJN.2018.4.3