Transarterial Embolization for Dural Arteriovenous Fistula Using a Flow-Control Technique and Intraluminal Shunt

BACKGROUND AND IMPORTANCE: Flow-controlled transarterial embolization (TAE) enables better penetration of liquid embolic agents into an intracranial dural arteriovenous fistula (DAVF). However, when temporary occlusion impairs normal cerebral blood flow, application of this technique can be limited. CLINICAL PRESENTATION: A woman in her 60s who had a history of cerebral infarction and received antiplatelet agents was diagnosed with Cognard type IV anterior cranial fossa DAVF at the stroke onset, fed by bilateral ophthalmic arteries (OphAs). She was scheduled to undergo Onyx TAE through the right OphA under flow control of the left OphA, the main feeder with flow-related aneurysm, by temporary occlusion of the left internal carotid artery. Owing to intolerance against temporary occlusion of the left internal carotid artery, we created an intraluminal shunt between a radial artery sheath and a dual-lumen balloon catheter used for temporary occlusion to maintain arterial blood flow into the affected hemisphere. Under flow control with the arterial shunt, successful obliteration of the DAVF was achieved without ischemic complications. CONCLUSION: Intraluminal shunt enabled flow-controlled Onyx TAE without interfering with cerebral blood flow.