Traumatic carotid-cavernous fistula treated by trans-arterial stent-assisted coil embolization: Technical note

Abstract

Background: Endovascular trans-arterial obliteration of a traumatic carotid-cavernous fistula (CCF) is often problematic because large fistulae can cause coils to protrude into the internal carotid artery (ICA) and disturb tight packing at the fistulous point. This technical note describes trans-arterial stent-assisted coil embolization to treat CCF. Case presentation: A 45-year-old woman presented with left chemosis at two months after sustaining head trauma. Digital subtraction angiography (DSA) showed direct CCF with a fistula in the cavernous segment of the left ICA communicating with the left cavernous sinus. We therefore planned trans-arterial stent-assisted coil embolization. An 8-Fr balloon guiding catheter was navigated into the left ICA and microcatheters were advanced into the cavernous sinus (CS) porch. A braided stent was deployed in the ICA over the fistular portion and coil embolization proceeded under balloon inflation and the CCF was immediately obliterated. Conclusion: Stent-assisted fistulous embolization is a safe and effective technical strategy for treating CCF. Braided stents might promote fistular obliteration by flow alterations and facilitate endothelialization of a lacerated arterial segment.

Keywords

• Carotid-cavernous fistula
• Stent-assisted coil embolization
• Shunt