E-088 Experience of covered coronary stent grafts as treatment option for carotid cavernous fistulas with follow-up results

Abstract

Introduction Endovascular detachable balloon occlusion and coil occlusion have been well-established options for the treatment of carotid cavernous fistulas. In recent years, sporadic treatment of CCFs endovascular covered stent grafting is proving an excellent result not only in successful treatment of fistula but also preserving patency of parent artery. However, only a few such cases have been reported in the literature while covered coronary stent grafts have been occasionally used in the intracranial vasculature. In this study, we present our experience of CCFs, treated by the placement of covered stents, and provide their clinical and angiographic follow-up results. Materials and methods Four consecutive patients with CCFs underwent the Jostent coronary stent graft (Abbott Vascular, Redwood City, CA) placement alone at our department during 2 years. Two were direct CCFs with a symptom triad and 2 were indirect CCFs with diplopia. These patients had periodic clinical follow-up examinations (at 6–29 months) with all receiving angiographic follow-up examination (at 5–15 months). Results Covered stent placement was technically successful in all patients. Immediate post-procedural complete exclusion of the fistula was achieved in 3 and near complete exclusion with small endoleak was observed in 1 after stent placement. ICA patency was preserved in all. Symptoms related to CCFs regressed within 1–14 days in all patients after treatment without thromboembolic events. There was no mortality and no immediate post-procedural morbidity related to the procedure. Final follow-up angiography showed complete exclusion of all CCFs and revealed good stent patency of the ICA without intra-stent stenosis. Conclusion Graft-stents should be considered as an alternative option of treating CCFs and preserving the parent artery by arterial wall reconstruction especially in patients with a fistula that cannot be successfully occluded with detachable balloons or coils. Disclosures S. Chung: None. S. Chang: None. M. Park: None.