Long-term outcome of Willis covered stent for direct carotid-cavernous fistula

This retrospective single-center study aimed to evaluate the safety, efficacy, and long-term outcomes of the Willis covered stent (WCS) in the treatment of direct carotid-cavernous fistula (dCCF).

Between November 2014 and November 2019, 13 patients with dCCF (out of 66 eligible cases) were enrolled and treated with WCS in our institution. Clinical characteristics, procedural details and follow-up data were collected and analyzed.

Technical success in WCS delivery and deployment was achieved in all 13 patients. No device-related or procedure-related complications were observed. Postoperative angiography demonstrated complete fistula occlusion in 10 patients (76.9%), minimal endoleak in 2 patients (15.4%), and minimal residual leakage in 1 patient (7.7%). Cranial bruit was resolved in all affected patients immediately after the procedure. Proptosis completely resolved in all 13 patients (100%) at the 1-month clinical follow-up (FU). During angiographic FU (mean duration: 9 ± 5.9 months), complete fistula occlusion and parent artery patency were maintained in all 13 patients (100%), with no recurrence of dCCF or in-stent stenosis detected. Long-term clinical FU data were available for 12 patients (92.3%), with a mean duration of 76.8 ± 29.7 months. Ocular symptoms fully resolved in 9 patients (75%), while persistent visual decline was noted in 1 patient (8.3%) and permanent visual loss with mild ptosis was observed in 2 patients (16.7%).

Our findings demonstrated that WCS was a safe and effective therapeutic option for the treatment of dCCFs, with favorable long-term clinical outcomes. However, additional large-scale studies and prospective randomized controlled trials are warranted to validate these results.