In distal vascular lesions, such as the distal anterior inferior cerebellar artery or posterior inferior cerebellar artery (PICA) dissecting aneurysm, and dural arteriovenous fistula (dAVF) and arteriovenous malformation (AVM), super-selective catheterization and embolization using liquid agents, such as NBCA or Onyx liquid embolic system, is the preferred treatment.1 2 We used a flow-directed 1.5 Fr Marathon microcatheter (Medtronic, Minneapolis, MN, USA) for embolization because commonly used detachable coil-compatible microcatheters can be too short or rigid for superselection.3–6 We designed an in vitro coil compatibility test for the Marathon microcatheter and developed a ‘free-running’ technique (video 1). Using this technique, we trapped the distal PICA dissecting aneurysm and embolized the fistula points of dAVF precisely and safely without affecting adjacent normal structures, which can occur when applying liquid embolizing agents.1–3 After reviewing the case, we determined that this technique can also potentially be applied for implementing the pressure cooker technique7 and combining the management of AVM.4
- Arteriovenous Malformation
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Contributors Concept and design: CHO, CSC, WCL. Materials and methods: CHO, WCL, PLL, CLL. Software: CHO, PLL, CLL. Visualization: WW, PLL, CLL. Performed procedure: CHO, CSC, WCL. Drafting of the manuscript: CHO, WW. Critical review: WW, WCL, CSC. Supervision: CHO, WCL.
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 None declared.
Provenance and peer review Not commissioned; externally peer reviewed.