E-030 Transvenous Microguidewire Looping Technique for Breach of Ipsilateral Inferior Petrosal Sinus Occlusions En Route to Cavernous Sinus Dural Arteriovenous Fistulas

Purpose Transarterial access to dural arteriovenous fistulas (dAVFs) has been popularized by device improvements and novel embolic materials. However, this approach is limited in the cavernous sinus (CS) due to related complications and low cure rates. Although a transvenous approach, via ipsilateral inferior petrosal sinus (IPS), may be more suitable for CS-dAVFs, microcatheter delivery is occasionally impeded by ipsilateral IPS occlusion. Described herein is a novel microguidewire looping method to breach such occlusions, thus enabling access to CS lesions. Methods A microcatheter is initially advanced into IPS orifice, and a microguidewire is passed into occluded IPS. Looping is easily achieved through the resistance met. With greater support of the guiding catheter, the microguidewire (still looped) is then advanced into CS. When nearing CS, the microcatheter is further reinforced, and it is navigated along the microguidewire into CS. Results This technique was applied in 10 instances of CS-dAVF with ipsilateral IPS occlusion, enabling ipsilateral access to CS. In 8 cases (80%), microdevice advancement was successful, culminating in effective transvenous coil embolization. Clinical and radiologic outcomes in all patients were excellent, with no delayed post-procedural cranial palsies. Conclusion This microguidewire looping technique enables safe and effective entry into CS during transvenous coil embolization of CS-dAVFs with ipsilateral IPS occlusion. Disclosures Y. Cho: None. H. Kang: None. M. Han: None.