Traumatic carotid artery–cavernous sinus fistula treated with a covered stent

Abstract

The authors describe the cases of two patients with unilateral traumatic caroticocavernous fistulas in whom a self-expanding covered stent was successfully used to obliterate the fistula after failed occlusion with detachable balloons and coils. They discuss this option as a primary therapeutic modality in cases in which detachable balloons or coils, with or without a bare stent, have failed to obliterate the fistula. The placement of a covered stent to occlude the lesion from the outset may represent a new therapeutic approach to the treatment of these lesions.

Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients

“…It also supports the prior experience by Madam et al, 20 who administered clopidogrel for 3 months and ASA for 6 months in 2 patients with CCF and stent grafts, who did not develop signs of thrombosis and demonstrated patency of the artery at 6 months angiographic follow-up. From prior animal studies, we know that PTFE-covered stents are well endothelized (over 90% of their surface area) in 4 weeks.…”

“…36 Our observations add to prior reports in which minimal or no intimal hyperplasia was identified in patients treated with stent grafts for a vascular process other than atherosclerotic vaso-occlusive disease. [20][21][22]24,25,30,32,37,38 This contrasts with the experience reported in the coronary and venous bypass circulation, where significant restenosis was reported in approximately 30% of the patients with known atherosclerotic disease and associated risk factors. 39,40 Despite the encouraging preliminary results in our series and other similar series previously cited, the number of patients with CCF treated with covered stents remains small, and additional investigation is required to determine the long-term outcome of this treatment method.…”

“…29 The use of covered stents to treat CCF has been described in previous case reports, with successful occlusion of the fistula and preservation of the ICA in 5 patients with follow-up between 3 and 14 months (mean, 8.2 months). [20][21][22] Additional encouraging experience with the intracranial use of covered stents has been reported for the treatment of intracranial aneurysms and pseudoaneurysms. 21,24,25,[30][31][32][33][34][35] In our series, we successfully occluded 7 of 7 fistulas.…”

“…Bare stents and covered stents have been recently introduced as another set of alternatives to provide support to the coils or to directly obliterate the fistula. 14,[20][21][22]28 The CCF with complete transection of the ICA constitutes a particularly challenging therapeutic situation that, in most cases, requires occlusion of the ICA to cure the fistula. 8,10,12,14,17 Preservation of the artery in patients with CCF and severe laceration of the ICA has been feasible by using simultaneous bare stent and balloon-assisted coil obliteration.…”

“…14 To our knowledge, only a few cases of covered stents to treat CCF with short-term follow-up have been described in the English literature. [20][21][22] We present our experience in 7 cases of CCF treated with covered stents with midterm follow-up between 1 month and 3.5 years (mean, 18.4 months).…”