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Angiographic Follow-Up of Traumatic Carotid Cavernous Fistulas Treated with Endovascular Stent Graft Placement

E. Archondakisa, G. Peroa, L. Valvassoria, E. Boccardia and G. Scialfaa

a From the Servizio di Neuroradiologia, Ospedale Niguarda Ca’ Granda, Milan, Italy


Figure 1
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  		Fig 1. Case 3. A and B, lateral right ICA angiograms show the CCF before (A) and after (B) treatment; arrows point to stent extremities.

C, lateral view showing the stent and 4 detachable balloons previously used; 2 balloons partially inflated were used in an attempt to occlude the right CCF, whereas the 2 deflated balloons occluded the left CCF 2 months earlier.


Figure 2
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  		Fig 2. Case 8. A, Lateral angiogram of the ICA showing total steal of the flow toward the cavernous sinus; vertebral and contralateral ICA angiographies (not reported) showed steal also from posterior and contralateral circulation.

B, Lateral ICA angiogram at the end of the stent-graft placement procedure showing nearly complete occlusion of the CCF.

C and D, ICA angiogram in lateral projection of day 2 after treatment showing partial reopening of the fistula (C) and the result after angioplasty with a coronary balloon.

E, Lateral ICA angiogram 3 months later showing persistence of the fistula with regularization of intracranial hemispheric circulation (note different diameter of distal ICA and posterior communicating artery between D and E).


Figure 3
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  		Fig 3. Case 5. Lateral angiograms show the postprocedural occlusion of the CCF (A) and the intimal hyperplasia causing a 30% reduction of the ICA lumen at the 6-month follow-up (B), with a possible improvement at the 1-year follow-up (C). Arrows point to the stent extremities. The marker of the previously released balloon is visible anterior to the ascending segment of the carotid siphon.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X