XCalibur aneurysm occlusion device for the treatment of direct carotid cavernous fistula: expansion of armamentarium

Abstract

We report the first case of a post-traumatic direct carotid cavernous fistula (CCF) treated with the XCalibur aneurysm occlusion device, which is a balloon mounted stent with flow diversion effect. Two devices were deployed across the fistula in an overlapping manner, resulting in complete occlusion of the fistula. Flow diversion with this device can provide a safe and alternative treatment option in direct CCF.

Cavernous carotid artery large aneurysm treated with a new flow diverter – Xcalibur aneurysm occlusion device (AOD)

“…The Xcalibur AOD was preferred because of its higher flow diversion capability, and having been used to treat direct CCF at our institute. 15 In the present case, Xcalibur AOD has shown results comparable to the other flow diverters. 5,8,9,11 In our index case there was total aneurysm occlusion with complete resolution of the mass effect related symptoms at 6 months follow up.…”

Patch Technique for Primary Treatment of Type A Carotid Cavernous Fistula: A Case Series and Technical Notes

“…One patient with low-flow CCF had complete resolution after 1 FD only. Biswas et al 10 reported a case of post-traumatic direct CCF treated with only 2 overlapping FDs (XCalibur aneurysm occlusion device).…”

“…Recent literature has described the role of PED for salvage treatment of previously coiled or Onyx embolized Type A CCFs or as a stand-alone treatment. 9,10,12 Other descriptions of PED use for CCF have been used in staged fashions after initial CCF embolization with Onyx. [6][7][8] Here, we describe our patch technique (PT) for transarterial sole treatment of 3 high-flow Type A CCFs with preservation of the normal anatomy of the ICA and the cavernous sinus.…”

“…3,4 The pipeline embolization device (PED) is a flow diverter with increased metal coverage of 28%-33% that has been increasingly used as an adjunct in the treatment of Type A CCFs [5][6][7][8] and less commonly as a sole treatment. [9][10][11][12] In this study, we describe our experience, technique, and outcomes with using PED solely for transarterial treatment of high-flow CCFs using sequentially enlarging flow diverters (FDs) to increase metal coverage and overcome the aspiration effect of the fistula pressure gradient (Fig. 1).…”