Advanced Application of "Blank Roadmap" Technique for Transvenous Approach

The "blank roadmap" technique has been used to access occluded inferior petrosal sinus, which is not visualized on the venous phase of an angiogram. In this video article, we applied this technique to navigate the guidewire/microcatheter through the torcula and cavernous sinus. Torcula and cavernous sinus are a "carrefour" of veins and sinuses, with highly variable anatomic area and complex structure. They can serve as an access relay to distal targets in transvenous embolization during treatment of dural AVF or brain AVM, allowing access to the contralateral side. However, navigating a catheter device through these complex structures, which are not always clearly visible on venography, is challenging. We describe the advanced application of the "blank roadmap" technique for challenging cases of transvenous embolization for dural AVF and brain AVM.