{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T04:39:18Z","timestamp":1769229558231,"version":"3.49.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u202f\u00b1\u202f5.9\u202fmonths), 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\u202f\u00b1\u202f29.7\u202fmonths. 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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1753105","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T10:56:16Z","timestamp":1769079376000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcome of Willis covered stent for direct carotid-cavernous fistula"],"prefix":"10.3389","volume":"17","author":[{"given":"Tao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufeng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoqiang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xing","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zijian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Si","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenwei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tangdu Hospital, Air Force Medical University","place":["Xi\u2019an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3171\/jns.1985.62.2.0248","article-title":"Classification and treatment of spontaneous carotid-cavernous sinus fistulas","volume":"62","author":"Barrow","year":"1985","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.nec.2004.08.004","article-title":"Carotid cavernous fistulas: anatomy, classification, and treatment","volume":"16","author":"Ringer","year":"2005","journal-title":"Neurosurg Clin N 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