Traumatic carotid-cavernous fistulas treated with covered stents: experience of 12 cases

Covered stents have recently become available for intracranial use, such as aneurysms, arterial dissections and carotid-cavernous fistulas (CCFs). However, there have been few reports of the successful application of covered stents for the treatment of traumatic CCFs (TCCFs). The purpose of this study is to investigate the efficacy and safety of endovascular treatment of TCCFs with covered stent.

Twelve consecutive patients with TCCFs treated with covered stent after initial failure of traditional techniques are presented. All the patients were followed up both clinically and angiographically for a mean of 22.5 months.

Eleven of the 12 patients had covered stents placed successfully. In one case, the covered stent placement failed after multiple attempts because of the tortuous anatomy of the internal carotid artery (ICA). Complete occlusion was achieved in nine cases immediately after stent deployment. Endoleak was observed in case 4 and redilation was performed to avoid the endoleak. In case 8, improved symptoms recurred the next morning, and cerebral angiogram revealed a small endoleak; redilation was performed to eliminate the endoleak successfully. Spasm of the ICA was observed in six cases, but angioplasty was not required. Symptoms improved in all cases after stent placement. Angiographic follow-up demonstrated complete occlusion of the TCCFs and patency of ICA, and no intra-stent stenosis or embolization occurred in the 11 patients who received successful stent placement.

Although larger sample and long-term follow-up are required, our series shows that covered stent is an effective, safe, and microinvasive method to treat TCCFs.