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      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

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          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.

          MATERIALS AND METHODS:

          Nine consecutive patients presenting with dural arteriovenous fistulas of the transverse and sigmoid sinuses underwent combined transarterial and transvenous balloon-assisted endovascular embolization. Prospectively collected data were reviewed to assess the technical success rate, complication rate, and clinical outcome.

          RESULTS:

          Six patients presented with clinically symptomatic Borden type I, and 3 patients, with Borden type II dural arteriovenous fistulas of the transverse and sigmoid sinuses (3 men, 6 women; mean age, 50.4 years). Transarterial embolization was performed with a double-lumen balloon with Onyx and concomitant transvenous sinus protection with a dedicated venous remodeling balloon. Complete angiographic occlusion at the latest follow-up (mean, 4.8 months) was achieved in 6 patients, and near-complete occlusion, in 2 patients. Clinical cure or remission of symptoms was obtained in 6 and 2 patients, respectively. One patient with a residual fistula underwent further treatment in which the dural arteriovenous fistula was cured by sinus occlusion. Complete occlusion of the dural arteriovenous fistula was visible on the follow-up angiography after final treatment in 8 patients. One patient refused follow-up angiography but was free of symptoms. There were no immediate or delayed postinterventional complications.

          CONCLUSIONS:

          Transarterial balloon-assisted embolization of dural arteriovenous fistulas of the transverse and sigmoid sinuses with combined transvenous balloon protection is safe and offers a high rate of complete dural arteriovenous fistula occlusion and remission of clinical symptoms.

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          Author and article information

          Journal
          AJNR Am J Neuroradiol
          AJNR Am J Neuroradiol
          ajnr
          ajnr
          AJNR
          AJNR: American Journal of Neuroradiology
          American Society of Neuroradiology
          0195-6108
          1936-959X
          October 2017
          : 38
          : 10
          : 1984-1989
          Affiliations
          [1] aFrom the University Institute of Diagnostic and Interventional Neuroradiology (E.P., F.Z., T.D., J.G., P.M., P.J.M.)
          [2] bDepartment of Neurosurgery (D.B., A.R.), Inselspital, University of Bern, Bern, Switzerland.
          Author notes

          Jan Gralla and Pasquale Mordasini contributed equally to the study.

          Please address correspondence to Pasquale Mordasini, MD, MSc, University Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstr 10, 3010 Bern, Switzerland; e-mail: pasquale.mordasini@ 123456insel.ch
          Author information
          http://orcid.org/0000-0001-5609-0998
          http://orcid.org/0000-0002-6578-0605
          http://orcid.org/0000-0002-6167-3343
          http://orcid.org/0000-0001-5111-1972
          http://orcid.org/0000-0003-4873-4452
          http://orcid.org/0000-0002-3886-466X
          http://orcid.org/0000-0003-1953-9033
          http://orcid.org/0000-0003-1712-4168
          Article
          PMC7963627 PMC7963627 7963627 17-00283
          10.3174/ajnr.A5333
          7963627
          28818827
          202a94a0-b9f7-4aab-a1c6-a787b899aec2
          © 2017 by American Journal of Neuroradiology

          Indicates open access to non-subscribers at www.ajnr.org

          History
          : 13 March 2017
          : 1 June 2017
          Categories
          Interventional

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