Fig. 1

Case example. Case 4 of hybrid surgery for a symptomatic chronic internal carotid artery occlusion (ICAO) and a new development of intraprocedural carotid-cavernous fistula (CCF). a, b Left ICAO, revealed by preoperative angiographies on lateral and posterior-anterior projection, respectively. c A new development of intermediate-flow CCF with anterior and inferior drainage, along with spiral and cervical-to-cavernous ICA dissection after surgical removal of the ICAO plaque, revealed by angiographies via PLUS microcatheter (Codman & Shurtleff, Raynham, MA). d Angiography via the guiding catheter following negotiation of the assembly of microcatheter and microwire into normal ICA distal to the dissection. e, f Successful ICA recanalization and complete CCF obliteration after telescopically deploying one 7 × 40 mm Wallstent (Boston Scientific Corporation, Natick, MA) and two 4.5 × 37 mm Enterprise stents through the true channel of the dissection. g, h Durable patency of the left ICA and complete CCF obliteration on follow-up CT angiogram at 6 months