• Tomotaka Ohshima, Reo Kawaguchi, Shigeru Miyachi, and Naoki Matsuo.
• Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan. Electronic address: tmtkoh@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 360-364.

BackgroundPersistent primitive trigeminal artery (PPTA) is the most common type of fetal carotid-basilar persisting communication in adulthood; however, carotid-cavernous fistulas (CCFs) associated with PPTA are rare.Case DescriptionAn 84-year-old woman presented with traumatic CCF associated with PPTA manifesting as vascular bruit. Transarterial embolization was performed. Although a detachable coil was deployed at the fistula point, it was easy to migrate into the cavernous sinus because of the high-flow shunt. Therefore, a stent was deployed in the PPTA, and the inner lumen of the stent with a focus on the fistula point was occluded by using coils. Subsequently, the CCF completely disappeared.ConclusionsIn-stent coil embolization was effective and reasonable for the high-flow CCF associated with the PPTA. This method reduced the number of coils required and operating time. However, careful preservation of perforators is needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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