Introduction Traumatic injury to the cavernous carotid artery may be difficult to manage as it often requires emergent treatment due to the potential for life threatening hemorrhage. Since this segment of artery is difficult to access surgically, frequently endovascular treatment by either parent artery occlusion or stent grafting is necessary.

Methods This is a prospective case series of 29 patients who had traumatic cavernous carotid injury or spontaneous hemorrhage who had placement of one or more stent grafts in the cavernous carotid artery for treatment. Patients were loaded with either 300 mg or 600 mg of clopidogrel and 325 mg of aspirin either a few hours prior to the endovascular procedure or via an oral gastric tube at the time of the procedure. Patient also received intraprocedure intravenous heparin. They were then maintained on clopidogrel and aspirin for 6 months and then aspirin alone from then on. Follow-up imaging was performed at 6 months post intervention, and patients were then followed up clinical on an annual basis.

Results Of the 29 patients who had treatment, 10 patients had iatrogenic injury to the carotid artery from surgery with epistaxis, 14 patients had direct traumatic carotid cavernous fistula and two patients had epistaxis or subarachnoid hemorrhage from a gunshot wound. Three patients had prior malignant skull base tumor resection with radiation therapy that developed acute epistaxis. Two of the patients developed thromboembolic events within the first 30 days of treatment. With an average imaging follow-up of 2.7 years, two patients had asymptomatic occlusion of their stent grafts, 22 patients had patent stent grafts and five patients had no imaging follow-up.

Conclusions Stent grafts provide a safe alternative to deliberate parent artery occlusion in patients with spontaneous hemorrhage or traumatic to the cavernous carotid artery. With aggressive antiplatelet therapy, a long term symptomatic thromboembolic rate of 7% was seen.