Introduction: Direct carotid-cavernous sinus fistulas (CCF) are high flow arteriovenous shunts that are typically the result of a severe head injury. The treatment of these lesions has included use of detachable balloons, coils, liquid embolic agents, and covered stents. In order to minimize the chance of treatment failure and complications, endoluminal reconstruction can be added to the treatment construct by placement of a flow-diverting device in as an adjunct to coil or balloon placement.
Methods: Case series presentation and review of the literature
Results: 3 patients with traumatic direct CCF were treated by fistula closure with coils, coils and Onyx, and detachable balloon, followed by placement of Flow-Diverter stent for endoluminal reconstruction. All 3 cases had complete occlusion of CCF, followed by clinical recovery. No complications were observed.
Conclusions: We believe that endovascular coil or balloon occlusion of the fistula from either a transvenous or transarterial approach, followed by flow diversion is the appropriate paradigm for treatment of direct CCFs. This treatment produces a biologic situation where there is fistula obliteration complemented by endoluminal reconstruction with flow diversion.
Patient Care: It will increase the efficacy
Learning Objectives: a new protocol for treating direct CCF