Endovascular treatment of a traumatic direct carotid-cavernous fistula using the Amplatzer Vascular Plug II

To report the use of the second-generation Amplatzer Vascular Plug II (AVP II) for the treatment of a posttraumatic type A carotid-cavernous fistula (CCF).

To achieve complete treatment of a CCF, the decision was taken to occlude the parent carotid artery after angiographic assessment. A 6-mm AVP II was deployed in the petrous segment of the ICA. Post-deployment angiography revealed minimal residual flow, so a first-generation AVP I was also deployed. Immediate flow cessation was achieved, without residual proximal or distal inflow from the contralateral side to the fistula. At 8 months, the size of the right cavernous sinus had significantly reduced, with complete occlusion of the ICA and no residual flow in the fistula.

The AVP II may be a useful complementary device in the neurointerventional armamentarium for parent artery occlusion.