J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):306-314. 10.7461/jcen.2016.18.3.306.

Recurrent Carotid Cavernous Fistula Originating from a Giant Cerebral Aneurysm after Placement of a Covered Stent

• Baek JW
• Kim ST
• Lee YS
• Jeong YG
• Jeong HW
• Baek JW
• Seo JH

• KMID: 2355660
• DOI: http://doi.org/10.7461/jcen.2016.18.3.306

Abstract

We report the case of a recurrent carotid cavernous fistula (CCF) originating from a giant cerebral aneurysm (GCA) after placement of a covered stent. A 47-year-old woman presented with sudden onset of severe headache, and left-sided exophthalmos and ptosis. Cerebral angiography revealed a CCF caused by rupture of a GCA in the cavernous segment of the left internal carotid artery. Two covered stents were placed at the neck of the aneurysm. The neurological symptoms improved at first, but were aggravated in the 6 months following the treatment. Contrast agent endoleak was seen in the distal area of the stent. Even though additional treatments were attempted via an endovascular approach, the CCF could not be cured. However, after trapping the aneurysm using coils and performing superficial temporal artery-middle cerebral artery bypass, the neurological symptoms improved. In cases of recurrent CCF originating from a GCA after placement of a covered stent, it is possible to treat the CCF by endovascular trapping and surgical bypass.

Keyword

Carotid-cavernous sinus fistula; Intracranial aneurysm; Stents

MeSH Terms

Aneurysm
Carotid Artery, Internal
Carotid-Cavernous Sinus Fistula
Cerebral Angiography
Cerebral Arteries
Endoleak
Exophthalmos
Female
Fistula*
Headache
Humans
Intracranial Aneurysm*
Middle Aged
Neck
Rupture
Stents*

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