Introduction There are no studies investigating the safety and efficacy of covered stent grafts, particularly the newly developed stents such as the PK Papyrus stent, for endovascular treatment of direct carotid cavernous fistulas (CCFs)

Aim of Study To report a case of direct CCF that was treated by PK Papyrus stent covered stent graft

Methods We present a case of a 75-year-old female who was found to have left direct Type A CCF secondary to ruptured cavernous segment carotid aneurysm. The CCF was treated with coil embolization and pipeline Shield stent embolization devices with immediate stagnation and improvement of symptoms. Patient had history of an aortic mechanical valve and thus was started on warfarin and aspirin. After achieving INR level of 2.5–3.5, patient started to have recurrent swelling of the left eye and decreased visual acuity

Results Repeated diagnostic cerebral angiogram revealed residual CCF. Onyx liquid embolization and a Surpass Evolve Flow Diverter were attempted to slow the fistulization with no success. Multiple attempts for direct percutaneous superior ophthalmic vein cannulation were also unsuccessful. At this point, two coronary graft-covered PK Papyrus stents were implanted across the fistula pouch, which resulted in immediate resolution of the CCF with evidence of persistent normal flow within left ophthalmic artery. Patient’s visual acuity and left eye movement improved

Conclusion Papyrus PK covered Stent is safe and effective in treating complex direct CCF

Disclosure of Interest None