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Abstract
Introduction/Purpose Vaso-CT is a cone beam imaging technique that provides high-resolution vessel imaging intra-operatively to better delineate key anatomic information of cerebrovascular structures. Dural arteriovenous fistulas (dAVFs) are pathological anastomoses characterized by arterial feeders draining directly into dural leaflets of a venous sinus. Most adult dAVFs are located along the transverse, sigmoid and cavernous sinuses. Endovascular embolization can be successfully performed by specifically targeting the venous pouch, eliminating the need of trans-arterial embolization or take down of the venous sinus. We evaluated the use of Vaso-CT during dAVF embolization for identification and endovascular targeting of the venous pouch.
Materials and Methods We retrospectively reviewed our neurointerventional database and identified all patients who underwent dAVF embolization between January 2018 and January 2024. We further the cases in which a Vaso-CT was performed to help guide endovascular embolization of the vascular lesion. Patient characteristics, procedural data and outcome information was collected.
Results We identified two patients (1 male, 1 female) in whom a Vaso-CT was performed to help identify and target the dAVF venous pouch for endovascular embolization. Angiographic imaging in both cases was not able to clearly identify the architecture of the venous pouch and operators were not able to confidently choose the best endovascular route for embolization. The Vaso-CT was able to clearly visualize the anatomy of the dAVF as well as separate the venous pouch from the normal sinus. With the information from the Vaso-CT, operators were also able to select proper angiographic projections to access and safely embolize the venous pouch without the need for transarterial embolization or venous sinus takedown.
Conclusion Vaso-CT is a useful imaging tool to help successfully and confidently target the venous pouch for endovascular dAVF embolization.
Disclosures A. Kuhn: None. J. Singh: None. S. Marwah: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.