Cure of a direct carotid cavernous fistula by endovascular stent deployment

A 53-year-old woman underwent surgical thrombendarterectomy for treatment o f artherosclerotic stenoses of her left internal carotid artery (ICA). A Fo garty catheter was used during this operation. The postoperative course was complicated by the development of a sixth cranial nerve palsy, protrusio, chemosis and ciliar injection of both eyes. Digital subtraction angiography showed a direct fistula between the cavernous segment of the left ICA and the cavernous sinus, with early and retrograde opacification of both superi or ophthalmic veins. Endovascular occlusion of the fistula was achieved wit h preservation of the ICA by stent deployment over the rupture site of the ICA, as two detachable balloons could not obliterate the fistula while pres erving the ICA patent. Follow-up angiography 7 months after the endovascula r treatment confirmed persisting occlusion of the fistula with a patent ICA . Highly flexible porous coronary stents can easily be introduced into tort uous vessels, including the distal ICA. The haemodynamic effects achieved b y stent deployment together with two balloons detached in the cavernous sin us may be sufficient to interrupt a direct carotid cavernous fistula. Copyr ight (C) 2001 S. Karger AG, Basel.