Reconstruction of traumatic carotidcavernous fistula using a covered stent - Case report

Sep 28, 2026

Uploaded by McQueen

A 23-year-old male developed persistent left eye pain, redness, and proptosis seven months after a motor vehicle collision, with examination showing conjunctival injection, diplopia, and a CN VI deficit. Imaging confirmed a high-flow traumatic carotid-cavernous fistula with direct and indirect components and compromised distal internal carotid artery flow. Endovascular management achieved staged closure by coil embolizing accessory feeders, followed by carotid reconstruction using a 5 mm PK Papyrus covered stent delivered via a novel tri-axial catheter system, demonstrating feasibility of large-diameter intracranial covered stents.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Case description

Endovascular treatment and outcomes

Case Report Journal of Cerebrovascular and Endovascular Journal of Cerebrovascular and Endovascular Neurosurgery pISSN 2234-8565, eISSN 2287-3139, [https://doi.org/10.7461/jcen.2025.E2025.05.004](https://doi.org/10.7461/jcen.2025.E2025.05.004) Neurosurgery Reconstruction of traumatic carotidcavernous fistula using a covered stent Julio Calderon1, Ravi Shastri2, Guhanand Venkataraman1, Mohadese Ahmadzade1, Mohammad Ghasemi-Rad2 1Department of Radiology, Baylor College of Medicine, Houston, Texas, 7730, United States 2Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, Texas, 7730, United States J Cerebrovasc Endovasc Neurosurg. 2025 December;27(4):380-384 Received: 30 April 2025 Revised: 14 July 2025 Accepted: 8 August 2025 Correspondence to Mohammad Ghasemi-Rad Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, Texas, 7730, United States Tel +1 713-798-495 E-mail [mdghrad@gmail.com](mdghrad@gmail.com) ORCID [https://orcid.org/0000-0001-6763-900X](https://orcid.org/0000-0001-6763-900X) A traumatic carotid-cavernous fistula (CCF) is a significant neurovascular condition characterized by an abnormal connection between the carotid artery and the cavernous sinus, often resulting from head trauma. This condition can lead to serious complications, necessitating effective management strategies. Endovascular treatment is the preferred approach for managing this condition. We present a case of a 23-year-old male with persistent left eye pain and redness seven months post-motor vehicle collision. Cerebral angiography confirmed a high-flow CCF with compromised intracranial flow, successfully treated with a 5 mm PK Papyrus covered stent using a novel tri-axial delivery system. This case highlights the efficacy of covered stents inneurovascular interventions and introduces an innovative approach for deploying a large-diameter stent across the cavernous internal carotid artery. Keywords Carotid cavernous fistula, Arteriovenous fistula, Endovascular procedures, Stents, Covered stent This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous communications between the carotid arterial system and the cavernous sinus, most frequently resulting from traumatic head injury. These lesions can lead to debilitating ophthalmologic and neurologic sequelae, including vision loss, proptosis, cranial nerve deficits, and intracranial hemorrhage, due to venous hypertension and vascular steal phenomena.2) Consequently, while endovascular intervention remains the gold standard for treatment, the optimal approach must reconcile two competing priorities: complete fistula occlusion and preservation of parent vessel patency to prevent ischemic complications. 1)3) Traditional endovascular strategies, such as transarterial or transvenous embolization with coils or liquid embolics, often achieve fistula closure but may require 380 [www.the-jcen.org](www.the-jcen.org) Copyright © 2025 by KSCVS and KoNES sacrifice of the internal carotid artery (ICA) in complex cases, posing risks of cerebral hypoperfusion. Covered stents have emerged as a promising alternative, enabling direct exclusion of the fistula while maintaining ICA integrity.4) However, their intracranial application has been historically limited by technical challenges, including navigational constraints in tortuous anatomy and the risk of stent thrombosis or endoleaks.4)5) This case report describes a 23-year-old male with CCF

FAQs

What is the main condition described in the case?

The case involves a traumatic carotid-cavernous fistula (CCF), an abnormal arteriovenous connection between the carotid artery and the cavernous sinus.

Why was endovascular treatment chosen?

Endovascular treatment is presented as the preferred approach, with the goal of occluding the fistula while preserving parent vessel patency to avoid ischemic complications.

How was the fistula treated in this patient?

The indirect component was occluded with multiple coils, then the direct component was treated with carotid reconstruction using a 5 mm PK Papyrus covered stent delivered by a novel tri-axial catheter system.

Sep 28, 2026

Uploaded by McQueen