Direct Carotid-Cavernous Fistula following Intracavernous Carotid Aneurysm Treatment with a Flow-Diverter Stent

A 39-year-old woman presented with a right intra-cavernous carotid aneurysm measuring 1.76 cm×1.33 cm. The aneurysm was treated with a self-expandable flow-diverter stent. Follow-up MRI showed normal flow in the internal carotid artery with partial thrombosis of the aneurysmal sac. Two weeks later, the patient developed a right direct carotid-cavernous fistula. The fistula was treated by transvenous route. We concluded that rupture of a previously unruptured aneurysm can occur after treatment with a flow-diverter stent.