Abstract
Objective: The ED Coil Inifini® (Kaneka, Osaka, Japan) features a large loop design and excellent flexibility to provide better embolization within an irregularly shaped cavity. The authors report two cases of direct carotid-cavernous fistula (direct CCF) treated using an endovascular approach with the ED Coil Inifini®.
Case presentation: Case 1: An 83-year-old woman presented with direct CCF manifesting as sudden-onset right pulsatile tinnitus. After the failure of transarterial embolization and transvenous embolization via the inferior petrosal sinus, a transvenous embolization from the facial vein via the superior ophthalmic vein was planned. We failed to occlude the fistula point using other ED coils. Subsequently, we used the ED Coil Inifini® and achieved a complete occlusion of the fistula point. Recanalization was not detected at 8 months after the treatment. Case 2: A 72-year-old woman presented with a direct CCF manifesting as sudden-onset right pulsatile tinnitus. Placement of the ED Coil Inifini® was performed via the transarterial and transvenous approaches. Although a mild shunt flow persisted, a favorable outcome was obtained. All the patients' symptoms disappeared after the treatment.
Conclusion: The ED Coil Inifini® expands in irregularly shaped spaces and can occlude an affected cavernous sinus even when the catheter cannot be navigated into the fistula point. Our cases demonstrated the usefulness of ED Coil Inifini® for the treatment of direct CCF.
