Treatment of High-Flow Carotid Cavernous Fistula Using a Graft Stent: Case Report

Abstract

Direct high-flow carotid cavernous fistula (CCF) may be associated with traumatic fracture of the skull base and the sphenoid bone, which produces a direct communication between the internal carotid artery (ICA) and the cavernous sinus (CS). The clinical manifestation of CCF is related to the venous drainage pattern, which may lead to various symptoms, such as pain, exophthalmos, conjunctival chemosis, visual impairment, ocular movement disorder, and intracranial hemorrhage. The goal of treatment of high flow CCF is to obliterate the arteriovenous shunt at the site of the fistula, while preserving the patency of the ICA as much as possible. The current treatment of choice is transarterial obliteration of the fistula with detachable coils. However, the use of detachable coils can lead to incomplete or temporary occlusion of the fistula due to its high blood flow velocity. An increasing body of evidence has demonstrated that a graft stent lined with polyfluorotetraethylene or Gore-Tex is an alternative for the treatment of CCF. We present our experience using a graft stent to treat high-flow CCF and review the pertinent literature to identify potential indications for a graft stent. Case Report