title: Covered stents for the endovascular treatment of a direct carotid cavernous fistula : single center experiences with 10 cases.
abstract: OBJECTIVE
  Covered stent has been recently reported as an effective alternative treatment for direct carotid cavernous fistulas (DCCFs). The purpose of this study is to describe our experiences with the treatment of DCCF with covered stents and to evaluate whether a covered stent has a potential to be used as the first choice in selected cases.
  
  
  METHODS
  From February 2009 through July 2013, 10 patients underwent covered stent placement for a DCCF occlusion. Clinical and angiographic data were retrospectively reviewed.
  
  
  RESULTS
  Covered stent placement was performed for five patients primarily as the first choice and in the other five as an alternative option. Access and deployment of a covered stent was successful in all patients (100%) and total occlusion of the fistula was achieved in nine (90%). Complete occlusion immediately after the procedure was obtained in five patients (50%). Endoleak persisted in five patients and the fistulae were found to be completely occluded by one month control angiography in four. The other patient underwent additional coil embolization by a transvenous approach. Balloon inflation-related arterial dissection during the procedure was noted in two cases; healing was noted at follow-up angiography. One patient suffered an asymptomatic internal carotid artery occlusion noted seven months post-treatment.
  
  
  CONCLUSIONS
  Although endoleak is currently a common roadblock, our experience demonstrates that a covered stent has the potential to be used as the first choice in DCCF; this potential is likely to increase as experience with this device accumulates and the materials continue to improve.
authors: Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China.
authors: Ke
authors: K
authors: Li
authors: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Young Dae
authors: YD
authors: Cho
authors: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Kang Min
authors: KM
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyun-Seung
authors: HS
authors: Kang
authors: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Jeong Eun
authors: JE
authors: Kim
authors: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Moon Hee
authors: MH
authors: Han
keywords: Carotid cavernous fistula; Covered stent; Endovascular treatment