This 66 year-old woman presented to the ophthalmologist with 3-days history of left eyelid swelling, exophthalmos, chemosis and corkscrew hyperaemia. Periorbital bruit was audible on the left side. MRI/MRA showed dilation of the left superior ophthalmic vein and expansion of the left cavernous sinus. DSA images raveled a direct, Barrow Type A, high-flow left carotid-cavernous fistula. The left ICA flow terminated into the left cavernous sinus. Transarterial and transvenous coiling (through the ipsilateral and contralateral inferior petrosal sinuses and the left superior ophthalmic vein) succeeded in closing the fistula and restoring the left anterior circulation. The unusual termination of the left common facial vein into the left subclavian vein was noted, it was used to gain access into the left superior ophthalmic vein, avoiding the need for an open surgical cannulation of the superior ophthalmic vein.

Disclosures K. Alok: None. J. Salame: None.