1098 Utilization of the PK Papyrus Covered Stent for the Treatment of Carotid Cavernous Fistulas

INTRODUCTION: Carotid cavernous fistulas (CCFs) pose significant challenges in management. Traditional treatment modalities include endovascular embolization, surgical ligation, observation and stereotactic radiosurgery. These approaches may be limited by their inability to effectively seal arteriovenous shunts while preserving vital vessels. Covered stents have been investigated as a promising alternative for various intracranial vascular pathologies, offering the potential to address these limitations via placement of an impermeable barrier across the site of the fistula. Prior covered stents were noted to be stiff and difficult to navigate in tortuous vessels. Complications such as endoleaks, vasospasm, restenosis, and thrombosis have also hindered their widespread adoption. Recently, there has been growing interest in exploring novel applications of covered stents in intracranial neurovascular intervention. This abstract presents a series of four cases illustrating the use of the PK Papyrus covered stent for CCF treatment. By leveraging the unique properties of the PK Papyrus stent, we demonstrate its potential as a safe and effective therapeutic option for challenging CCF cases. METHODS: We present a single-institution case series of 4 adult patients with carotid cavernous fistulas treated with the PK Papyrus covered stent. RESULTS: Four patients with Barrow Type A CCFs were successfully treated with the PK Papyrus stent. Complete obliteration of the CCF was noted in all cases. Intraoperative complication included only one incidence of spasm of the distal ICA that resolved with intra-arterial verapamil. Two of the four patients have completed follow up angiograms, one at 9 days and one at 6 months, without signs of endoleak, in-stent thrombosis or stenosis. CONCLUSIONS: The Papyrus covered stent is a viable option in complex CCF cases. Future multi-center studies are needed to investigate the long term efficacy of covered stents for treatment of CCFs.