Diagnosis and follow-up of carotid-cavernous fistulas by carotid duplex sonography and transcranial color Doppler imaging

Ultrasound Med Biol. 1996;22(9):1155-62. doi: 10.1016/s0301-5629(96)00152-4.


To investigate the suitability of extracranial carotid duplex (ECD) and transcranial color Doppler imaging (TCDI) in the diagnosis and follow-up of treatment in patients with carotid-cavernous fistulas (CCF), combined ECD and TCDI examinations were studied in seven patients with traumatic CCF. According to angiography, four patients had direct CCF, two indirect CCF and one both direct and indirect CCF. In ECD, hemodynamic parameters of the feeding artery showed an abnormally increased flow volume and decreased resistivity indices in five direct CCFs from the internal carotid artery and one indirect CCF from the external carotid artery. Direct visualization of the CCF was achieved in patients with direct CCF only, and revealed itself as a heterogeneous mosaic flash resulting from high flow velocities and turbulence. Patterns of venous drainage were detected via the transorbital and transforaminal windows in seven and five patients (four direct and one indirect CCF patients), respectively. These abnormal findings were improved or even normalized after successful treatment. In conclusion, combined ECD and TCDI examinations appear to be useful for the diagnosis and follow-up of CCF.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Arteriovenous Fistula / diagnostic imaging*
  • Arteriovenous Fistula / physiopathology
  • Arteriovenous Fistula / therapy
  • Blood Flow Velocity
  • Carotid Artery Diseases / diagnostic imaging*
  • Carotid Artery Diseases / physiopathology
  • Carotid Artery Diseases / therapy
  • Cavernous Sinus / abnormalities
  • Cavernous Sinus / diagnostic imaging*
  • Embolization, Therapeutic / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Ultrasonography, Doppler, Duplex / methods*
  • Ultrasonography, Doppler, Transcranial / methods*