Utility of the turn-back supporting technique using a steerable intermediate catheter: illustrative case

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Selective shunt occlusion (SSO) is a safe and effective treatment for intracranial dural arteriovenous fistulas (DAVFs).
• Adequate microcatheter support is crucial for successful obliteration of the shunted pouch in SSO.
• Challenges arise when microcatheter support is insufficient, potentially leading to incomplete treatment.

Purpose of the Study:

• To present a novel technique for improving microcatheter support during selective shunt occlusion (SSO) for complex intracranial dural arteriovenous fistulas (DAVFs).
• To demonstrate the efficacy of a steerable intermediate catheter (SIC) in facilitating complete obliteration of DAVFs.

Main Methods:

• A case report of a 68-year-old woman with multiple shunted DAVFs in the transverse-sigmoid sinus (TSS) and superior sagittal sinus (SSS).
• Utilized a transvenously introduced guiding catheter and a manually steered SIC to create a hairpin shape for support.
• Navigated a microcatheter into the fistula point over the supported SIC to deliver coils for obliteration.

Main Results:

• The turn-back supporting technique using the SIC successfully facilitated coaxial microcatheter navigation.
• Complete obliteration of the residual shunt flow in the venous pouch was achieved using only two coils.
• The technique provided adequate support and guidance, overcoming challenges in accessing the fistula point.

Conclusions:

• The turn-back supporting technique with an SIC is a valuable method for achieving successful selective shunt occlusion in complex intracranial DAVFs.
• This technique enhances microcatheter stability and maneuverability, leading to complete fistula obliteration.
• It offers a practical solution for cases where standard microcatheter support is inadequate.