• Jin Li, Zhi-gang Lan, Xiao-dong Xie, Chao You, and Min He.
• Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
• World Neurosurg. 2010 May 1; 73 (5): 514-9.

ObjectiveCovered stents have recently become available for intracranial use, such as aneurysms, arterial dissections and carotid-cavernous fistulas (CCFs). However, there have been few reports of the successful application of covered stents for the treatment of traumatic CCFs (TCCFs). The purpose of this study is to investigate the efficacy and safety of endovascular treatment of TCCFs with covered stent.MethodsTwelve consecutive patients with TCCFs treated with covered stent after initial failure of traditional techniques are presented. All the patients were followed up both clinically and angiographically for a mean of 22.5 months.ResultsEleven of the 12 patients had covered stents placed successfully. In one case, the covered stent placement failed after multiple attempts because of the tortuous anatomy of the internal carotid artery (ICA). Complete occlusion was achieved in nine cases immediately after stent deployment. Endoleak was observed in case 4 and redilation was performed to avoid the endoleak. In case 8, improved symptoms recurred the next morning, and cerebral angiogram revealed a small endoleak; redilation was performed to eliminate the endoleak successfully. Spasm of the ICA was observed in six cases, but angioplasty was not required. Symptoms improved in all cases after stent placement. Angiographic follow-up demonstrated complete occlusion of the TCCFs and patency of ICA, and no intra-stent stenosis or embolization occurred in the 11 patients who received successful stent placement.ConclusionAlthough larger sample and long-term follow-up are required, our series shows that covered stent is an effective, safe, and microinvasive method to treat TCCFs.Copyright © 2010 Elsevier Inc. All rights reserved.

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