Utilization of the PK Papyrus Covered Stent for the Treatment of Direct Carotid Cavernous Fistulas: A Case Series.

BACKGROUND AND OBJECTIVES: Carotid cavernous fistulas (CCFs) pose significant challenges in management. Traditional treatment modalities including endovascular embolization, surgical ligation, and even stereotactic radiosurgery, are often limited by their inability to effectively seal arteriovenous shunts while preserving perforating vessels. In recent years, covered stents have been investigated as a possible treatment option for various intracranial vascular pathologies, including CCFs, offering the potential to occlude sites of shunting or hemorrhage. Traditional covered stents were noted to be stiff and difficult to navigate in tortuous vessels, and complications such as endoleaks, vasospasm, restenosis, and thrombosis have also hindered their widespread adoption. METHODS: We present a retrospective, single-institution case series of 4 adult patients with direct CCFs treated with the PK Papyrus covered stent (Biotronik Inc.). 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. 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 1 incidence of vasospasm of the distal internal carotid artery that resolved with intra-arterial verapamil. All 4 patients have completed long-term follow-up angiograms demonstrating persistent fistula obliteration without signs of endoleak, in-stent thrombosis, or stenosis. CONCLUSION: The Papyrus covered stent is a viable option in treating direct CCFs. Future multicenter studies are needed to investigate the long-term efficacy of these devices for treatment of CCFs.