Transarterial embolization of dural arteriovenous fistulas of the lateral sinuses with stent-assisted sinus protection

Background The balloon-assisted sinus protection technique has been described as a sinus-preserving technique during transarterial embolization (TAE) of dural arteriovenous fistulas (DAVFs). However, some serious complications of this technique have been documented. Objective To describe our preliminary experience with a new technique called stent-assisted sinus protection (SSP). Methods We performed a retrospective analysis of seven consecutive patients with type I or IIa DAVFs of the lateral sinus treated by TAE with a closed-cell stent temporarily deployed in the sinus. Results Of the seven patients, four had type I DAVF, and three had type IIa DAVF. The patency of all involved sinuses and their tributaries (including the inferior anastomotic vein and the superior petrosal sinus) was preserved. At the end of the procedure, all stents were successfully retrieved with embolic particles trapped in their meshes. No procedural complications were noted. Clinical follow-up was satisfactory, with complete resolution or significant reduction of pulsatile tinnitus. Conclusions SSP appears to be feasible and probably safe. However, larger studies are needed to confirm these preliminary results.