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Direct puncture of the superficial temporal artery for ethylene vinyl alcohol embolization of a type 3 arteriovenous fistula with a dual lumen balloon
  1. Frédéric Clarençon1,2,
  2. Eimad Shotar1,
  3. Arnaud Pouvelle1,
  4. Samuel Mouyal1,
  5. Stéphanie Lenck1,
  6. Kevin Premat1,2,
  7. Philippe Cornu2,3,
  8. Nader-Antoine Sourour1
  1. 1 Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
  2. 2 Sorbonne University. Paris VI University, Paris, France
  3. 3 Neurosurgery, University Hospital Pitié-Salpêtrière, Paris, France
  1. Correspondence to Dr Frédéric Clarençon, Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris 75013, France; fredclare5{at}


Intracranial dural arteriovenous fistulas (dAVFs) may be difficult to treat by endovascular means, especially when the arterial feeders to the fistula are tortuous. 1 The usual main feeder to intracranial dAVFs is the middle meningeal artery, which may present very tight loops that are often difficult to cross with a microcatheter. 2 Direct puncture of a subcutaneous artery feeding the fistula indirectly via transosseous branches may be a valuable strategic option to overcome this limitation. 3 4 We report here the successful embolization of a Cognard type 3 parietal dAVF by direct puncture of the superficial temporal artery under roadmap guidance. The dAVF was subsequently embolized with ethylene vinyl alcohol via a dual lumen balloon, under balloon inflation. We highlight in this technical video 1 the potential difficulties and risks of direct puncture of the superficial temporal artery. We also stress the risk of delayed scalp necrosis using this technique.

Video 1.
  • fistula
  • technique
  • vascular malformation

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  • Contributors FC: data collection, manuscript writing, and video preparation. ES, AP, and SM: data collection and critical review of the manuscript. SL, KP, PC, and N-AS: critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; not related to the study), Codman Neurovascular, and Microvention (core lab; not related to the study). N-AS is a consultant for Medtronic, Balt Extrusion, and Microvention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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