Work

Long-term outcome of Willis covered stent for direct carotid-cavernous fistula

Year: 2026

Type: article

Abstract: Objective: This retrospective single-center study aimed to evaluate the safety, efficacy, and long-term outcomes of the Willis covered stent (WCS) in the treatment of direct carotid-cavernous fistula (dCCF). Methods: Between November 2014 and November 2019, 13 patients with dCCF (out of 66 eligible cases) were enrolled and treated with WCS in our institution. Clinical characteristics, procedural details and follow-up data were collected and analyzed. Results: Technical success in WCS delivery and deployment was achieved in all 13 patients. No device-related or procedure-related complications were observed. Postoperative angiography demonstrated complete fistula occlusion in 10 patients (76.9%), minimal endoleak in 2 patients (15.4%), and minimal residual leakage in 1 patient (7.7%). Cranial bruit was resolved in all affected patients immediately after the procedure. Proptosis completely resolved in all 13 patients (100%) at the 1-month clinical follow-up (FU). During angiographic FU (mean duration: 9 ± 5.9 months), complete fistula occlusion and parent artery patency were maintained in all 13 patients (100%), with no recurrence of dCCF or in-stent stenosis detected. Long-term clinical FU data were available for 12 patients (92.3%), with a mean duration of 76.8 ± 29.7 months. Ocular symptoms fully resolved in 9 patients (75%), while persistent visual decline was noted in 1 patient (8.3%) and permanent visual loss with mild ptosis was observed in 2 patients (16.7%). Conclusion: Our findings demonstrated that WCS was a safe and effective therapeutic option for the treatment of dCCFs, with favorable long-term clinical outcomes. However, additional large-scale studies and prospective randomized controlled trials are warranted to validate these results.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1753105