Usefulness of Stent-Assisted Coil Embolization of Direct Traumatic Carotid-Cavernous Fistulas: Report of Three Patients and Review of Other Treatment Methods

OBJECTIVE: Direct traumatic carotid-cavernous fisulas (dtCCFs) exhibit a high blood flow velocity and are often difficult to be treated. We report three dtCCF cases in which disappearance of the dtCCF and preservation of the internal carotid artery (ICA) were achieved by stent-assisted coil embolization of the fistula. We report these cases and compare them with those previously reported using other treatments. CASE PRESENTATIONS: In the first case, we performed coil embolization without stenting for the initial treatment. The cerebral venous reflux disappeared and the patient’s symptoms were temporarily ameliorated. However, 5 months after treatment, an aneurysm-like finding around the fistula was noted on MRA. Additional coils and insertion of a neck-bridging stent were required to obliterate the dtCCF and the symptoms disappeared. In the second and third cases, we intended to use stents initially to achieve tight embolization of the fistulas, and obliteration was achieved. CONCLUSION: Use of neck-bridging stenting for dtCCFs may be a reliable method to preserve the parent artery while achieving tight packing around the fistula.