Covered stent delivery in tortuous internal carotid artery for treatment of direct carotid cavernous fistula

Mehrnoush Gorjian , Scott Raymond , Matthew Koch , Aman Patel
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Abstract

Direct carotid cavernous fistulas (dCCF) are high-flow shunts between the internal carotid artery (ICA) and cavernous sinus and are commonly caused by traumatic injuries. Endovascular intervention using detachable coils, with or without stenting, is often the treatment of choice; however, migration or compaction of the coils can occur due to high-flow nature of dCCFs. Alternatively, deployment of a covered stent in ICA can be considered for treatment of dCCFs. We report a case of dCCF with tortuous intracranial ICA successfully treated by placement of a covered stent graft and we will illustrate the technical aspects of the procedure. In the presence of a tortuous ICA navigation and deployment of covered stents is technically complicated and requires modified maneuvers.

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弯曲颈内动脉覆膜支架置入治疗颈动脉海绵窦瘘
直接颈动脉海绵窦瘘(dCCF)是颈内动脉(ICA)和海绵窦之间的高流量分流,通常由创伤引起。使用可拆卸线圈的血管内介入治疗,无论是否植入支架,通常是首选的治疗方法;然而,线圈的迁移或压实可能由于dCCF的高流动性质而发生。或者,可以考虑在ICA中部署覆膜支架来治疗dCCF。我们报告了一例dCCF合并颅内弯曲ICA的病例,通过放置有盖支架移植物成功治疗,我们将说明该手术的技术方面。在存在曲折ICA的情况下,覆盖支架的导航和部署在技术上是复杂的,需要修改操作。
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