Treatment of direct carotid cavernous fistula with Willis covered stent with midterm follow-up

Abstract Background Willis covered stent is the first stent designed exclusively for intracranial vasculature and its application in carotid cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid cavernous fistula. Methods 10 consecutive patients with direct carotid cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed. Results Of the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-up for at least 24 months and 7 patients received angiographic follow-up. Symptoms relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case and no recurrence was observed. Conclusions Willis covered stent is feasible for direct carotid cavernous fistula.