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Research ArticleNeurointervention

Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients

F. Gomez, W. Escobar, A.M. Gomez, J.F. Gomez and C.A. Anaya
American Journal of Neuroradiology October 2007, 28 (9) 1762-1768; DOI: https://doi.org/10.3174/ajnr.A0636
F. Gomez
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W. Escobar
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A.M. Gomez
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J.F. Gomez
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C.A. Anaya
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Abstract

BACKGROUND AND PURPOSE: Carotid cavernous fistulas (CCF) can be effectively treated by using different therapeutic alternatives such as detachable balloons and detachable coils, alone or in combination with N-butyl-2-cyanoacrylate (n-BCA) or Onyx. Stents have also been used in an attempt to improve preservation of the parent artery while still occluding the fistula. We present our experience using balloon-expandable covered stents to treat CCF, focusing on arterial wall reconstruction. To our knowledge, this is the first series with midterm follow-up between 3 months and 3.5 years.

MATERIALS AND METHODS: From the 46 CCF treated at our institution between November 1998 and September 2006, a total of 7 posttraumatic direct CCF were treated using polytetrafluoroethylene (PTFE)-covered stents between April 2003 and September 2006. Five were treated with covered stents alone. One patient with transection of the internal carotid artery (ICA) first underwent bare stent placement to provide support for the covered stent. One patient had to be treated with coils and n-BCA.

RESULTS: Control angiograms obtained in the 7 patients demonstrated occlusion of the fistula and preservation of the ICA in all cases. There was no mortality and no immediate postprocedural morbidity. There was 1 case of morbidity identified at 1-month follow-up with asymptomatic occlusion of the ICA; the other 6 patients had angiographic follow-up between 3 and 42 months (mean, 18.4 months), with persistent occlusion of the fistulas, patent stent grafts, and no significant intimal hyperplasia.

CONCLUSIONS: PTFE-covered stents are evolving as a promising intracranial therapeutic alternative to treat CCF and preserve the parent artery by reconstructing the arterial wall. They should be considered in patients in whom fistulas cannot be successfully occluded with detachable balloons or detachable coils. More investigation is required to further develop their specifications and indications.

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American Journal of Neuroradiology: 28 (9)
American Journal of Neuroradiology
Vol. 28, Issue 9
October 2007
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Cite this article
F. Gomez, W. Escobar, A.M. Gomez, J.F. Gomez, C.A. Anaya
Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients
American Journal of Neuroradiology Oct 2007, 28 (9) 1762-1768; DOI: 10.3174/ajnr.A0636

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Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients
F. Gomez, W. Escobar, A.M. Gomez, J.F. Gomez, C.A. Anaya
American Journal of Neuroradiology Oct 2007, 28 (9) 1762-1768; DOI: 10.3174/ajnr.A0636
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  • Treatment of direct carotid-cavernous fistulas with a double lumen balloon
  • Multiple Unilateral Traumatic Carotid-Cavernous Sphenoid Sinus Fistulas with Associated Massive Epistaxis: A Consequence of Parkour
  • 4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm
  • Use of Onyx for Transarterial Balloon-Assisted Embolization of Traumatic Carotid Cavernous Fistulas: A Report of 23 Cases
  • Treatment of a traumatic carotid-cavernous fistula by the sole use of a flow diverting stent
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