Difficulties in Transvenous Embolization via the Cavernous Sinus: Buddy-Wire Anchoring Technique

The cavernous sinus drains venous blood from most of the temporal lobe through the superficial middle cerebral vein (SMCV).¹ Brain AVMs located on the surface of the temporal and parietal lobes often drain into the SMCV.² Therefore, in cases treated with transvenous embolization, accessing the SMCV passing through relaying the cavernous sinus (CS), which can interfere with the deployment of the microcatheter by trapping the catheter in the CS. In this video article, we describe a bailout technique for this situation using another microguidewire. This additional guidewire provides support by serving as an "anchor," enabling the microcatheter to advance. The buddy-wire anchoring technique can be used to help catheterize the SMCV distally without it becoming trapped in the CS. This is the first report of the buddy-wire anchoring technique described in transvenous embolization for brain AVMs.