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Vol. 34. Issue 2.
Pages 97-100 (March - April 2023)
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Vol. 34. Issue 2.
Pages 97-100 (March - April 2023)
Case Report
Covered stent delivery in tortuous internal carotid artery for treatment of direct carotid cavernous fistula
Colocación de un stent cubierto en una arteria carótida interna tortuosa para el tratamiento de la fístula carótida cavernosa directa
Mehrnoush Gorjiana,
Corresponding author

Corresponding author.
, Scott Raymondb, Matthew Kochc, Aman Pateld
a Department of Neurology, University of New Mexico, 900 Camino de Salud, Albuquerque, NM 87131, United States
b Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, United States
c Department of Neurosurgery, University of Florida, 1505 SW archer Rd, Gainesville, FL 32608, United States
d Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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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.


Las fístulas carótidas cavernosas directas (dCCF) son derivaciones de alto flujo entre la arteria carótida interna (ACI) y el seno cavernoso y suelen ser causadas por lesiones traumáticas. La intervención intravascular con espirales desmontables, con o sin stent, suele ser el tratamiento de elección; sin embargo, la migración o compactación de las bobinas puede ocurrir debido a la naturaleza de alto flujo de los dCCF. Alternativamente, se puede considerar el despliegue de un stent cubierto en la ACI para el tratamiento de dCCF. Presentamos un caso de dCCF con ACI intracraneal tortuosa tratada con éxito mediante la colocación de una endoprótesis cubierta e ilustraremos los aspectos técnicos del procedimiento. En presencia de una ACI tortuosa, la navegación y el despliegue de los stents cubiertos es técnicamente complicado y requiere maniobras modificadas.

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