Successful implantation of a large diameter peripheral stent in a dural arteriovenous fistula

Einleitung We report a successful implantation of a peripheral stent in a dural arteriovenous fistula (dAVF) over a j-shaped 0.035” steel-wire (Rosen). The patient was a 61-year old male presenting with a known dAVF Cognard 2b in the right sigmoid sinus. The jugular vein was thrombosed intracranially.

Amamnese Combined trans-arterial and transvenous balloon-protection would have been first line option, but the fistula was extensive along the transverse sinus and antegrade access was not easy to achieve due to vein thrombosis. Therefore an approach leading to downgrading (to Type I-fistula) and permanent re-opening of the jugular vein was identified as the better treatment option. Direct jugular vein puncture was carried out, the vein was catherized as far cranially as possible with a 4-french glide catheter and a Rosen steel wire (Radifocus, Tokyo, Japan) was used to reach the superior sagittal sinus (SSS). An Optimed sinus superflex-stent from the transverse sinus to the right JV was implanted. Post-implantation angiogram showed a significantly reduced flow in the feeding vessels and antegrade venous drainage of the right hemisphere. At three months the drainage was still patent and the fistula reduced to a type 1-fistula.

Diskussion In a challenging vascular anatomy we demonstrated feasibility of successful stent implantation in a dAVF over a 0.035” steel-wire with a residual Cognard 1 situation. We demonstrate that large diameter wires may be used safely in venous sinus and that stenting of dural fistulas without additional embolization can be enough to reduce a fistula significantly.

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Artikel online veröffentlicht:
29. August 2022