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Balloon-Assisted Superselective Microcatheterization for Transarterial Treatment of Cranial Dural Arteriovenous Fistulas: Technique and Results

Zhao, Wen-Yuan MD*; Krings, Timo MD, PhD; Yang, Peng-Fei MD*; Liu, Jian-Min MD*; Xu, Yi*; Li, Qiang MD*; Fang, Yi-Bin MD*; Huang, Qing-Hai MD*; Wu, Yong-Fa MD*

doi: 10.1227/NEU.0b013e3182684b70
Technique Assessment

BACKGROUND: In transarterial embolization of anterior cranial fossa and tentorial dural arteriovenous fistula (DAVF), acute angulation of the feeding artery off the internal carotid artery (ICA) may render stable distal catheterization and, therefore, successful transarterial treatment difficult. In some anatomic dispositions, following selection of the feeding artery, subsequent forward force may lead to prolapse of the microcatheter into the ICA rather than advancing it into either the ophthalmic artery or the meningohypophyseal trunk.

OBJECTIVE: We describe a technique that facilitates stable positioning of the microcatheter by using a nondetachable balloon to temporally block the ICA distal to the feeding artery to redirect the catheter into the feeder and to prevent the microcatheter from protruding into the parent artery.

METHODS: In 8 cases where routine superselective microcatheterization failed, a balloon was used to block the ICA distal to the feeding artery in an attempt to facilitate superselective microcatheterization. The balloon was inflated following selection of the feeding vessel with the microcatheter and was kept inflated while advancing the catheter.

RESULTS: Distal stable microcatheter positions could be obtained in all cases, which enabled us to treat the respective DAVFs with a liquid embolic agent. All 8 cases were angiographically cured with penetration of the liquid embolic agent from the distal artery to the proximal vein, and no procedure-related complications occurred.

CONCLUSION: The described technique may be a helpful adjunct to gain stable distal microcatheter positions during the transarterial treatment of DAVF.

ABBREVIATIONS: DAVF, dural arteriovenous fistula

ICA, internal carotid artery

SMMU, Second Military Medical University

*Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China

Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence: Jian-Min Liu, MD, Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China. E-mail:

Received May 13, 2012

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons