Utility of a Steerable Microcatheter for the Selective Transvenous Embolization of Dural Arteriovenous Fistulas

OBJECTIVE: Selective transvenous embolization (sTVE) is an effective technique for treating dural arteriovenous fistulas (DAVFs); however, selective catheterization into the shunted pouch is often difficult due to the acute angle of the access route between the target pouch and dural sinus. We present our initial experience using a steerable microcatheter (SM) to manually control the tip angle for selective catheterization and sTVE of DAVFs. METHODS: Thirteen consecutive cases of DAVFs and 16 procedures that involved sTVE using SM between October 2016 and October 2018 were reviewed. SMs were used for selective catheterization of shunted venous pouches and/or the affected sinus and coil embolization. We evaluated the maneuverability of the SM, the success of selective catheterization into the target lesions, and the results of endovascular treatments. RESULTS: Endovascular procedures were performed in a single session in 10 cases and in two staged sessions in 3 cases. There was no difficulty in maneuverability of the SM. Successful selective catheterization was achieved in 26 of 27 target lesions. Immediately after embolization, angiography showed complete occlusion in 10 cases and marked reduction in 3 cases. During 40.9 months of mean follow-up, 12 cases showed complete occlusion and one case showed a small residual shunt on MRI. Procedure-related complications of spontaneous thrombosis of the affected sinus were observed in one case. There were no cases of recurrence or exacerbation during follow-up. CONCLUSION: SM is useful for selective catheterization for target lesions during sTVE of DAVFs.