Triple Coaxial Catheter Technique for Transfacial Superior Ophthalmic Vein Approach for Embolization of Dural Carotid-Cavernous Fistula

Abstract

<jats:p> We report a triple coaxial catheter technique to facilitate the venous access to the superior ophthalmic vein during transvenous embolization of dural carotid-cavernous fistula (DCCF) via the transfacial venous route. Two patients with transvenous embolization of DCCFs by coils were treated with transfacial superior ophthalmic vein (SOV) approach by the triple coaxial catheter technique. The triple coaxial catheter system consisted of a 6F guiding catheter as the outer catheter and a 4F guiding catheter as the middle catheter and a microcatheter as the inner catheter to help navigation and manipulation. </jats:p><jats:p> The DCCFs were completely obliterated in both cases. There were no complications associated with the procedure. The ophthalmic symptoms of the patients had totally resolved at two-month follow-up. </jats:p><jats:p> The triple coaxial catheter technique can be used with the transfacial SOV approach in embolization of DCCF. This technique has two advantages over the double coaxial catheter technique because it offers additional length and support for the distal navigation of microcatheter into the SOV. </jats:p>

Anatomic Variation of Facial Vein in Carotid-Cavernous Fistula and Trans–Facial Vein Embolization

“…In this circumstance, establishment of an angiographic road map may be a great help to define the venous anatomy of the FV-EJV. In addition, a tortuous and looping FV may be found at at its insertion to the jugular vein; to support the microcatheter during navigation, 4F and 6F coaxial guiding catheters with engagement of the 4F tip at the orifice of the FV can be applied (16). Another common challenge of trans-FV embolization is advancement of the microcatheter from the FV to the angular vein and then to the SOV because of marked tortuous venous structures in these segments.…”

“…These venous variations occurred at a higher rate in our series than in previously published series and sporadic observations and led to initial erroneous placement of the guiding catheter and microcatheter in the IJV for trans-FV embolization in our first 2 CCF cases (Figures 1 and 3). Yuen et al (16) reported 2 cases of indirect CCFs in which trans-FV embolization was performed. The trans-EJV route was used in 1 case, and the trans-IJV route was used in the second case.…”

A Case of Postoperative Transverse Sinus Dural Arteriovenous Fistula Treated with Selective Sinus Packing: Usefulness of Quadriaxial Catheter System

“…Recently, it has been increasingly reported that the support force and manipulability can be obtained by the use of a multiple coaxial system. [24][25][26] In our patient, since the shunt point could be approached by recanalizing the occluded access route relatively safely with a quadriaxial system, selective embolization was possible. While consideration of the increase in the size of the puncture orifice is necessary in using a multiple coaxial system, it is considered to be more adoptable for TVE because the procedure is less stressful compared with transarterial embolization regarding the invasiveness and postoperative hemostasis.…”

A Case of Cavernous Sinus Dural Arteriovenous Fistula Treated by Transfacial Vein Placement of a Distal Access Catheter in the Cavernous Sinus

“…By the transfacial vein approach through the superior ophthalmic vein, to circumvent this problem, catheter navigation using a triple coaxial system has been attempted. 10,12) According to previous reports, penetration of the micro-catheter to the SOV and cavernous sinus could be supported by guiding a 4 Fr DAC to a point near the angular vein by a triple coaxial system using a 6 Fr guiding catheter with a 4 Fr DAC, and satisfactory embolization could be achieved. There have been other reports of the use of triple coaxial systems, but, in all these reports, the DAC was navigated only to a point near the angular vein and not beyond the SOV 10,12) because of the difficulty in access due to meandering of the angular vein and obstruction of venous drainage during treatment due to DAC insertion.…”

“…Various alternative access routes have been reported in case the trans-IPS approach is difficult to use. They include the facial vein, [10][11][12] is, a Target 360 Ultra soft (Stryker) 2 mm × 3 cm and a Target 360 nano 2 mm × 3 cm, were used. The procedural time was 2 hours and 45 minutes, and the radiation exposure was AP: 1629 mGy and Lat: 780 mGy.…”