Covered Stents for the Endovascular Treatment of a Direct Carotid Cavernous Fistula : Single Center Experiences with 10 Cases

Abstract

ObjectiveCovered stent has been recently reported as an effective alternative treatment for direct carotid cavernous fistulas (DCCFs). The purpose of this study is to describe our experiences with the treatment of DCCF with covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases.MethodsFrom February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed.ResultsCovered stent placement was performed for five patients primarily as the first choice and in the other five as an alternative option. Access and deployment of a covered stent was successful in all patients (100%) and total occlusion of the fistula was achieved in nine (90%). Complete occlusion immediately after the procedure was obtained in five patients (50%). Endoleak persisted in five patients and the fistulae were found to be completely occluded by one month control angiography in four. The other patient underwent additional coil embolization by a transvenous approach. Balloon inflation-related arterial dissection during the procedure was noted in two cases; healing was noted at follow-up angiography. One patient suffered an asymptomatic internal carotid artery occlusion noted seven months post-treatment.ConclusionAlthough endoleak is currently a common roadblock, our experience demonstrates that a covered stent has the potential to be used as the first choice in DCCF; this potential is likely to increase as experience with this device accumulates and the materials continue to improve.

Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent

“…Depending on the individual case, various materials, such as detachable balloons, coils, liquid material, and stents can be used 6)9)11)13)18)21). Currently, the covered stent is the preferred treatment option 1)8)12)16)20). However, spontaneous ICA occlusion and endoleaks frequently occur after placement of a covered stent 1)8)12)16)20).…”

“…Currently, the covered stent is the preferred treatment option 1)8)12)16)20). However, spontaneous ICA occlusion and endoleaks frequently occur after placement of a covered stent 1)8)12)16)20). The covered stents in current use were designed for coronary arteries, and may be too stiff to navigate distal to the lesion and fit the cavernous siphon of the ICA appositely, frequently resulting in endoleaks.…”

“…At present, the first-line approach to treat CCF involves selecting an endovascular approach 6)9)11)17). Furthermore, covered stents are frequently used for treatment of direct CCFs 12)16)20). However, the first treatment attempt is not always successful.…”

“…However, the first treatment attempt is not always successful. In this situation, a second treatment attempt (i.e., repeat endovascular treatment, surgical treatment, or a combination of both) should be considered 11)12). We report the case of a recurrent CCF originating from a giant cerebral aneurysm (GCA) after placement of a covered stent.…”

The Endovascular Treatment of Traumatic Cavernous Sinus Arteriovenous Fistulas: A Single-center Experience

“…If the fistula is large, there is a risk of protrusion of coils toward the internal carotid artery and incomplete occlusion, but tight packing may cause mass effect to the cavernous sinus. 4) Presently, various techniques and devices are applied to close fistulas, including balloon-assisted coil packing, 5) covered stents, 6) flow diverting stents, 7) and liquid embolic agents such as Onyx, 4) but it is necessary to accurately determine the site of fistula in the internal carotid artery, measure the fistula diameter, and select the procedure and device accordingly. 8) There has not been a report evaluating the relationship between the vascular structure or diameter of fistulas in the internal carotid artery and the procedures selected for their treatment, probably because of the difficulty in evaluating the vascular structure and diameter of fistulas by common cerebral angiography.…”