Abstract
BackgroundWillis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid-cavernous fistula.MethodsTen consecutive patients with direct carotid-cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed.ResultsOf the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-ups for at least 24 months and 7 patients received angiographic follow-up. Symptoms were relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case, and no recurrence was observed.ConclusionsWillis covered stent is feasible for direct carotid-cavernous fistula.
Highlights
Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited
Direct carotid-cavernous fistula (CCF) is featured by a direct shunt between the internal carotid artery (ICA) and the cavernous sinus, which mainly results from head traumas that damaged the cavernous ICA
Spontaneous direct CCF may occur after rupture of a cavernous ICA aneurysm
Summary
Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. In 1974, Serbinenko reported his experience with detachable balloons for treating CCFs [2]. This technique results in closure of the fistula with ICA (2021) 7:41 preservation in up to 80% of cases and has been the first-line therapy for direct CCFs [3]. Easy delivery and low cost are the main advantages of this technique It has some technical problems such as early detachment/deflation of the balloon or occasional rupture of the balloon stabbed by the bone fragments [4]. Liquid embolic agents including n-butyl cyanoacrylate and Onyx have been used solely or in combination with coils in treating direct CCFs with favorable results [6, 7]. The potential of the embolic agent refluxing into the ICA or draining veins is the main disadvantage of this approach [8]
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