Neurointervention.  2024 Jul;19(2):111-117. 10.5469/neuroint.2024.00157.

Treatment of Traumatic Direct Carotid-Cavernous Fistula with a BeGraft-Covered Stent

• Seraj FQM
• Najafi S
• Raaisi AA
• Mirbolouk MH
• Ebrahimnia F
• Shamsi HP
• Garivani Y
• Zabihyan S
• Mowla A
• Baharvahdat H

• KMID: 2556663
• DOI: http://doi.org/10.5469/neuroint.2024.00157

Abstract

The widely accepted option for treating traumatic direct carotid-cavernous fistula (dCCF) has been endovascular treatment using detachable balloons, coils, or embolic agents. Covered stent deployment has been applied by a few operators and has shown promising results. This is a retrospective study on patients with dCCF treated by an endovascular approach using BeGraft, a covered stent. In 4 cases, this device was successfully deployed without any complications. Immediate complete occlusion was achieved in 3 patients (75%) after deployment of the covered stents. One patient required transvenous coiling for occlusion of the remaining endoleak. Follow-up imaging demonstrated 100% fistula occlusion with complete internal carotid artery patency. No early or late complications occurred following treatment. In conclusion, the BeGraft-covered stent could be a promising safe and effective alternative option for the endovascular treatment of dCCF.

Keyword

Carotid-cavernous sinus fistula; Stent; Endovascular technique

Figure

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  Fig. 1. Patient 4. (A) The lateral view of cerebral digital subtraction angiogram demonstrates direct traumatic carotid-cavernous fistula (CCF). (B) The plain skull lateral view showed the BeGraft stent (between black arrows). (C) The lateral view of the digital subtraction angiography angiogram showed endoleak after stent deployment. (D) The plain skull lateral view showed balloon inflation (arrow) in the BeGraft stent. (E) Final images of the endovascular procedure showed complete resolution of the CCF with preservation of the internal carotid artery. (F) The follow-up computed tomography angiogram showed stent without in-stent stenosis.

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  Fig. 2. Patient 3. (A) The cerebral digital subtraction angiography (DSA), lateral view demonstrates traumatic direct carotid-cavernous fistula with cortical venous reflux, the internal carotid artery (ICA) size before fistula was about 5 mm. (B) The plain lateral view showed BeGraft stent 5–18 (between arrows), deployed in the cavernous-petrous part of the ICA. (C) Lateral DSA showed endoleak after stent deployment and re-dilatation with balloon, (D) lateral DSA view showed persistent leak into the cavernous sinus despite BeGraft deployment and adding 13 coils in the cavernous sinus pouch, and (E, F) follow-up DSA lateral and anterior posterior view showed complete resolution of endoleak.

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