Endovascular treatment of posttraumatic carotid-cavernous fistulas and pseudoaneurysms with covered stents.

OBJECTIVE: The treatment of posttraumatic direct carotid-cavernous fistulas (TCCFs) with detachable balloons (DBs) is associated with relatively high recanalization rate. The aim of this study was to evaluate the feasibility of using covered stents in patients with posttraumatic carotid-cavernous fistulas (CCFs) and pseudoaneurysms.

METHODS: Twelve patients with posttraumatic CCFs and 3 with pseudoaneurysms following detachable balloon deployment referred for treatment with covered stents were enrolled into this prospective study. Data on technical success, initial and final angiography results, mortality, morbidity, and the final clinical outcome, were retrospectively collected and analyzed at 1-, 3-, 6-, 12-months, and then annually.

RESULTS: The navigation and deployment of the covered stents to the target CCF were technically successful in 14 of the 15 attempted stents, giving a successful technical rate of 93.3%. Angiography poststent placement showed complete occlusion in 11 patients with 11 CCFs, and incomplete occlusion in 3. Follow-up angiography revealed complete occlusion and no obvious in-stent stenosis in any patient. Clinical follow-up demonstrated full recovery in 13 patients, and an unchanged status in 1.

CONCLUSION: These preliminary results indicate that the use of a covered stent is a feasible procedure for the treatment CCFs and pseudoaneurysms.