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E-068 Treatment of carotid-cavernous fistula presenting with contralateral exophthalmos; several experiences of graft stent
  1. S Chung,
  2. S Chang
  1. Neurosurgery, Eulji University Hospital, Daejeon, Korea, republic of


Object Endovascular detachable balloon occlusion and coil occlusion have been well-established options for the treatment of carotid cavernous fistulas (CCFs). Sporadic treatment of CCFs endovascular covered stent grafting is recently proving an excellent result not only in successful treatment of fistula but also preserving patency of parent artery. In this study, we experienced CCF of a patient who underwent the contralateral exophthalmos in addition to 5 CCF with ipsilateral symptoms treated by graft stent.

Method A 64-year old female presenting with left-sided decreased vision, exophthalmos, injection, and periorbital bruit was found to have a right-sided carotid-cavernous fistula. In addition, we experienced 6 consecutive patients with CCFs underwent the graft stent placement alone at our department during 4 years. Two were direct CCFs with a symptom triad and 4 were indirect CCFs with diplopia or exophthalmos. These patients had periodic clinical follow-up examinations (at 0–29 months) with all receiving angiographic follow-up examination (at 0–15 months).

Results Covered stent placement was technically successful in all 6 patients. Immediate post-procedural complete exclusion of the fistula was achieved in 3 and near complete exclusion with small endo-leak was observed in 3 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. Follow-up cerebral angiography showed complete exclusion of 3 included the two with previous small endo-leak. However, one who had complete exclusion immediately recur the filling during follow-up. This patient treated with re-dilation of the stent using balloon. 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. Although a larger sample and expanded follow-up are needed, our series shows that covered stents can be used in the treatment of CCFs with symptomatic relief as experience.

Disclosures S. Chung: None. S. Chang: None.

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