Microcatheter navigation using a large compliant balloon placed in a cortical vein during transvenous access

Transvenous embolization (TVE) has emerged as the new approach for the curative treatment of brain arteriovenous malformations (bAVMs), though challenges persist in navigating microcatheters through dural venous sinuses. This video article demonstrates a novel balloon-assisted technique to facilitate microcatheter navigation in a complex case of bAVM. A large compliant Copernic RC balloon was temporarily placed in a cortical vein, serving as a buttress to guide the microcatheter into the draining vein. This method enabled the successful cannulation and advancement of a microcatheter in a draining cortical vein using a large compliant balloon without complications. The case highlights the technical feasibility and safety of this approach in TVE for challenging bAVM cases.neurintsurg;jnis-2025-023596v1/V1F1V1Video 1 Microcatheter navigation using a large compliant balloon placed in a cortical vein during a transvenous access.