• Elizabeth Jee, Michael Folse, Rahul Shah, Lauren Lange, Sandeep Kandregula, Himanshu Chokhawala, Bharat Guthikonda, Hugo Cuellar, and Amey Savardekar.
• Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
• World Neurosurg. 2024 Oct 1; 190: 504510.e4504-510.e4.

BackgroundHere we describe our experience managing intracranial dural arteriovenous fistulas (DAVFs) via endovascular embolization using a transarterial embolization (TAE) technique with liquid embolic agents. We illustrate the technical nuance of using dual arterial access for angiographic control runs in complex DAVFs supplied by multiple feeders from 2 distinct arterial systems.MethodsRetrospective analysis of intracranial DAVF embolization as a single treatment technique at our institution from 2013 to 2023.ResultsTwenty-three patients with intracranial DAVF who underwent endovascular treatment as their initial treatment were included. All embolizations were approached transarterially with Onyx (n = 19), n-butyl cyanoacrylate (n = 2), or a combination (n = 2). Twenty-two patients (96%) had angiographic evidence of complete fistula obliteration after initial embolization. Six DAVF TAEs were performed with dual arterial access for simultaneous embolic delivery and angiographic control intraoperatively. Two patients recanalized twice postprocedure, 1 of whom was found to have incidental new DAVF at follow-up. Median patient follow-up was 12 months (interquartile range, 6-36 months), with a median modified Rankin Scale score on discharge of 1 and a Glasgow Outcome Scale score at 3 months of 5.ConclusionsIn this initial series of patients with DAVF managed by endovascular embolization, dual arterial access was feasible, safe, and effective in achieving fistula obliteration. Dual-arterial access conveniently provides simultaneous access for control angiography and embosylate delivery intraoperatively.Copyright © 2024 Elsevier Inc. All rights reserved.

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