Tunnelling for gold (through an occluded SOV in CCF)

• 75-year-old male patient
• History of redness, swelling and visual disturbance in the right eye for 3 weeks
• No diplopia or tinnitus
• Slightly elevated intraoccular pressure

Right CCF

Diagnostic angiogram

• Right CCF supplied by inferolateral trunk
• Minimal right ECA supply
• Minimal contralateral left ICA ILT supply
• Right Superior ophthalmic vein -> Right facial vein drainage
• No IPS drainage

Facial vein drains into EJV

• Patient undecided about treatment
• 3 months later, worsening of chemosis, proptosis and IOP
• Embolisation planned

Right ICA Angio

• Interval occlusion of SOV !!
• Slow draining IOV
• Minimal facial vein opacification
• Right IPS occluded

Right EJV -> Facial vein navigation

Tunnelling through occluded SOV

ICA Run (Intermediate catheter in facial vein) Microcatheter Run at fistulous point

Fibered coils at fistulous point

Complete occlusion of CCF

Progress

• Resolution of clinical symptoms
• Normalisation of IOP