Endovascular Treatment of Dural Arteriovenous Fistulas of the Transverse and Sigmoid Sinuses Using Transarterial Balloon-Assisted Embolization Combined with Transvenous Balloon Protection of the Venous Sinus

Abstract

BACKGROUND AND PURPOSE:Combined transarterial balloon-assisted endovascular embolization with double-lumen balloon microcatheters and concomitant transvenous balloon protection was described as a promising treatment technique for dural arteriovenous fistulae of the transverse and sigmoid sinus. The purpose of this study was to evaluate the technical efficacy and safety of this combined treatment technique.

Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus

“…A promising technique for avoiding inadvertent occlusion of normal veins during transarterial embolization of dAVFs, which was first described by Shi et al 13 in 2009, is the transient placement of a balloon in the affected venous sinus. 6,[8][9][10] The studies with the highest case numbers reporting this technique are those by Piechowiak et al 6 and Ertl et al 12 in 2017. Piechowiak et al 6 conducted a retrospective study of 9 patients with fistulas of the transverse and sigmoid sinuses who were treated using a technique that is similar to the technique described here.…”

“…When applied on the arterial side, they can be used for reduction of the blood flow of the fistula, for enhancement of distal migration of the embolic agent while simultaneously reducing the amount of reflux, and for improvement of embolization control. [4][5][6][7] In the venous system, balloon catheters can be used for protecting the venous sinuses and nontarget veins from unwanted embolization. 6,[8][9][10] In dAVFs with a high risk for venous nontarget embolization, especially fistulas at the transverse or sigmoid sinus, this aspect is of particular importance because nontarget embolization risks occlusion of functionally relevant venous drainage, potentially leading to venous congestion, venous infarction, or intracerebral hemorrhage.…”

“…[4][5][6][7] In the venous system, balloon catheters can be used for protecting the venous sinuses and nontarget veins from unwanted embolization. 6,[8][9][10] In dAVFs with a high risk for venous nontarget embolization, especially fistulas at the transverse or sigmoid sinus, this aspect is of particular importance because nontarget embolization risks occlusion of functionally relevant venous drainage, potentially leading to venous congestion, venous infarction, or intracerebral hemorrhage. 11,12 Transarterial embolization in combination with transvenous balloon protection is a promising approach for the effective treatment of dAVFs with prevention of nontarget emboliza-tion of the venous sinuses or normal superficial veins.…”

“…So far, only a few studies on this technique with a relatively small number of patients are available. 6,8,9,12,13 The aim of this study was to report our consecutive singlecenter experience of patients with dAVFs who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the venous sinus and to present the feasibility, effectiveness, and safety of this treatment technique.…”

Perspective review on applications of optics in cerebral endovascular neurosurgery

“…With the evolution of endovascular neurosurgery, the first-line treatment option for most dAVF is now endovascular embolization. 47 Trans-arterial embolization techniques using glue are often very expensive, in the range of $20,000 per procedure, and may require multiple procedures.…”