{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:21:59Z","timestamp":1760955719092,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,6,2]]},"abstract":"<jats:p>This is a case of a high-flow, post-traumatic direct carotid-cavernous fistula with a widened arterial defect and a large-diameter internal carotid artery (ICA). The unique aspect of this case is the oversized ICA, &gt;8mm in diameter, which is both a pathological and a therapeutic challenge, given the lack of available neuroendovascular devices for full vessel reconstruction. We present a planned two-stage embolisation paradigm for definitive treatment. Transarterial coil embolisation is performed as the first stage to disconnect the fistula and normalise flow in the ICA. A 3-month recovery period is then allowed for reduction in carotid diameter. Repair of the large vessel defect and pseudoaneurysm is performed as a second stage in a delayed fashion with a flow-diverting device. Follow-up angiography at 6 months demonstrates obliteration of the fistula and curative ICA reconstruction to a diameter &lt;5mm.<\/jats:p>","DOI":"10.1136\/bcr-2017-219662","type":"journal-article","created":{"date-parts":[[2017,6,15]],"date-time":"2017-06-15T02:10:24Z","timestamp":1497492624000},"page":"bcr-2017-219662","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Staged curative treatment of a complex direct carotid-cavernous fistula with a large arterial defect and an 'oversized' internal carotid artery"],"prefix":"10.1136","volume":"2017","author":[{"given":"Matthew T","family":"Bender","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Mei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California Irvine School of Medicine, Irvine, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1105-4333","authenticated-orcid":false,"given":"Alexander L","family":"Coon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3376-0933","authenticated-orcid":false,"given":"Geoffrey P","family":"Colby","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,6,14]]},"reference":[{"key":"2025082707480141000_2017.jun13_5.bcr-2017-219662.1","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2014-011235.rep"},{"key":"2025082707480141000_2017.jun13_5.bcr-2017-219662.2","doi-asserted-by":"crossref","unstructured":"Nossek E , Zumofen D , Nelson E , et al . Use of Pipeline embolization devices for treatment of a direct carotid-cavernous fistula. 157. 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