Risk-reduction strategies for endovascular treatment of falcotentorial dural AVFs

CategoryRisk-Reduction StrategyPatients Treated
Anatomic assessment; to identify supply from ADSMagnified high-frame-rate angiography1–6
3D rotational angiography with multiplanar reconstructions1–6
Transarterial embolization; strategies to avoid reflux across ADSInitial embolization from non-ADS arterial supplies (to reduce competitive flow)1–6
Close monitoring for linear reflux anteriorly from the vein of Galen (along the expected course of ADS)1–6
Embolization directly via ADS; strategies to treat via ADS while avoiding refluxDirect cannulation of ADS with embolization if distal access achieved (pressure-cooker technique to minimize reflux)2
Aborting embolization attempts from ADS if distal access not achieved (insufficient safety margin)1
Strategies for residual ADS supplyStaged embolization over multiple sessions as required1, 3, 5
Transvenous approach (eg, reverse pressure-cooker technique)1