Spontaneous Thrombosis and Complete Disappearance of Traumatic Carotid-cavernous Fistulas After Angiography

Traumatic carotid-cavernous fistula (TCCF) is a direct shunting fistula due to a tear in the cavernous portion of the internal carotid artery (ICA). Spontaneous thrombosis of the high-flow shunts in TCCFs is extremely rare. Most cases are treated using endovascular embolization to relieve the clinical presentations. We report 2 unusual cases of TCCF with spontaneous closure of fistulas at intervals of 2 and 10 days, respectively, after diagnostic angiograms. The possible mechanisms of spontaneous healing of the fistulas in these patients with minor head injury and small fistulas were presumed to be a transient decrease in fistula blood flow because of irritation of and/or subtle injury to the ICA by contrast media and/or catheter during diagnostic angiogram, with thrombosis formation at the fistula.