Fig. 2.

A 54-year-old female with life threatening epistaxis after transsphenoidal pituitary adenoma surgery. A : Lateral angiogram of left ICA demonstrating iatrogenic TCCF with pseudoaneurysm formation (black arrow) at horizontal segment of cavernous ICA. B and C : After the covered stent was deployed (white arrow), complete occlusion of CCF was confirmed. D : Oblique delayed angiography after covered stent deployment showed ICA stenosis distal to the stent, which confirmed vasospasm (black arrow). E : Recurrent epistaxis developed 2 days after covered stent treatment and angiography confirmed endoleak at distal end of the stent (black arrow). F : After repeated balloon angioplasty (black arrowhead), angiography showed a decrease of fistula flow but still persisted. G and H : Microcatheter (white arrow) selection through fistula point at distal end of the stent and additional stent assisted coiling was done (black arrow). I and J : Follow-up anterior and lateral angiography showed stable occlusion of fistula. ICA : internal carotid artery, TCCF : traumatic carotid cavernous fistula.