Balloon Anchoring To Traverse The Sigmoid Sinus For Delivery Of Large-Caliber Venous Stents: A Technical Note

BackgroundIn the reconstruction of the superior sagittal sinus or transverse sinus, it is desirable to place a large-diameter guiding catheter into the transverse sinus to introduce the stent delivery system smoothly. The utility of an anchoring technique with a percutaneous transluminal angioplasty (PTA) balloon for navigating an 8 F guiding catheter into the transverse sinus is demonstrated.Case Descriptions: Two dural arteriovenous fistula (dAVF) cases (Cognard type II a +b, Borden type II) that underwent sinus stenting are presented. In both cases, when the 8 F guiding catheter was placed in the jugular vein, the stent delivery system could not enter the transverse sinus because it could not pass through the transverse-sigmoid sinus junction. Introduction of an 8 F guiding catheter into the transverse sinus was attempted but failed. An 8-mm or 9-mm PTA balloon was used as a distal anchor, and this technique allowed easier guiding of catheter advancement into the transverse sinus. In both cases, Carotid WALLSTENTS were placed in the sinus easily, with no complications.ConclusionBalloon anchoring in the venous system is useful for achieving large-caliber catheter access across difficult anatomy and is technically feasible.