Superior Sagittal Sinus Dural Arteriovenous Fistulas Treated by Stent Placement for an Occluded Sinus and Transarterial Embolization

Abstract

<jats:p> We describe a case of dural arteriovenous fistulas (DAVFs) involving the superior sagittal sinus (SSS) successfully treated with stent placement for an occluded sinus and transarterial embolization. </jats:p><jats:p> A 61-year-old man who had been treated with anticoagulation for a known SSS thrombosis presented with a sudden onset of headache. CT scan revealed an intraventricular hemorrhage and cerebral angiography revealed DAVFs involving the SSS which had severe venous congestion and sinus occlusion. We treated this case with a staged endovascular approach which consisted of stent placement for the occluded sinus and transarterial intravenous embolization resulting in complete eradication of DAVFs. </jats:p><jats:p> Recanalization of an occluded sinus by stent placement can reduce venous congestion and transarterial intravenous embolization can obliterate dural arteriovenous shunts. This staged strategy is feasible and should be considered a first option of treatment, especially for DAVFs which presented with intracranial hemorrhage and aggressive venous hypertension. </jats:p>

Torcular dural arteriovenous fistula treated via stent placement and angioplasty in the affected straight and transverse sinuses: case report

“…Therefore, in cases in which there is no evident shunt point, such as the venous pouches and parasinuses, but there is diffuse shunt flow in the affected sinus, stent placement with or without angioplasty in the affected sinus can be an effective treatment to occlude the DAVF and preserve normal cerebral venous sinus drainage. 3,[6][7][8][9]12,15 Stent selection among patients with DAVF is a matter of some debate. An investigation performed by Levrier et al 6 showed that the inner endoluminal compression force on the sinus wall is related to the stent radial force and is dependent on the mechanical characteristics of the stent.…”

Selective Transvenous Embolization Combined with Balloon Sinoplasty for the Treatment of Intracranial Dural Arteriovenous Fistulas with Sinus Occlusion

“…1-3) Some technical reports have described using luminal angioplasty or stent placement to treat occluded dural sinuses and reconstruct antegrade venous drainage. [4][5][6][7][8][9][10][11][12][13][14][15][16] In addition, recent anatomical considerations of the parasinuses have enabled us to achieve selective embolization of the shunted venous pouch. 17) To our knowledge, selective transvenous embolization (TVE) combined with balloon sinoplasty (STVEBS) has not been reported.…”

Successful Stentings for Bilateral Jugular Bulb Stenosis/Occlusion in a Case of Bilateral Transverse Sinuses Dural Arteriovenous Fistulas: Case Report

“…[5][6][7][8][9][10][11] In most reported cases, stenosis/ occlusion was present in the affected sinus with AV shunt, and stent was placed in expectation of obliteration of the shunt site by compressing the sinus wall as well as preservation of the antegrade venous outflow tract by dilating the sinus. On the other hand, in a small number of reported cases, stents have been placed in the stenotic/occluded portion of the venous sinus distant from the affected sinus similar our case.…”

“…On the other hand, in a small number of reported cases, stents have been placed in the stenotic/occluded portion of the venous sinus distant from the affected sinus similar our case. 5) Stents have often been placed not only in the TS to SS, [6][7][8] but also in the SSS 9,10) or straight sinus. 5,11) The stents used were often balloon-or self-expanding closed-cell type, [5][6][7]9,11) but a few instances of balloon-expanding covered stent have also been reported.…”

“…5) Stents have often been placed not only in the TS to SS, [6][7][8] but also in the SSS 9,10) or straight sinus. 5,11) The stents used were often balloon-or self-expanding closed-cell type, [5][6][7]9,11) but a few instances of balloon-expanding covered stent have also been reported. 8,10) There have been no reports on stenting for stenosis/occlusion of the jugular bulb and placement of an opencell stent in the sinus in the literatures.…”