Fig 1.

Images in a 49-year-old man with a left TCCF and a TCA of the supraclinoid ICA.

A, Left frontal carotid angiogram shows a TCCF with moderate steal phenomenon. The aneurysm was overlooked because of its small size and masking by a nearby parent artery and its venous drains.

B, A detachable balloon was placed into the CS with subtotal occlusion of the TCCF. A small TCA about 3 × 2 mm was found at the left supraclinoid ICA (arrow).

C, Occlusion of the TCA was achieved by the use of a Guglielmi detachable coil (GDC). Because of the progressive, increased residual fistula flow, the residual TCCF was subsequently obliterated by using GDCs and liquid adhesive, with preservation of the ICA.