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Direct Puncture of the Superficial Temporal Artery for EVOH Embolization of a Type 3 Arteriovenous Fistula with a Dual Lumen Balloon

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Clarençon, Frédéric | Shotar, Eimad | Pouvelle, Arnaud | Mouyal, Samuel | Lenck, Stéphanie | Premat, Kevin | Cornu, Philippe | Sourour, Nader-Antoine

Edité par CCSD ; BMJ Journals -

International audience. 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.

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