Use of the LEONIS Mova Steerable Catheter in the Treatment of Cavernous Sinus Dural Arteriovenous Fistula with Occluded Inferior Petrosal Sinus.

Abstract

Objective: LEONIS Mova high-flow type (SB-KAWASUMI LABORATORIES, Kanagawa, Japan) is a steerable microcatheter that enables angle adjustment of the catheter tip using a hand-operated dial, and available as a coaxial microcatheter system with a 1.6-F microcatheter. It was used to navigate an occluded inferior petrosal sinus (IPS) in a patient with cavernous sinus (CS) dural arteriovenous fistula (AVF).

Case presentation: A man in his 50s presenting with right eye congestion was diagnosed with dural AVF of the CS with bilateral occluded IPSs. The shunted pouch was located in the medial-lateral part of the right CS, with drainage into the superior ophthalmic vein. Transvenous embolization (TVE) from the femoral vein via the occluded IPS was performed. A 6-F guiding catheter was navigated to the right internal jugular vein, and LEONIS Mova high-flow type combined with a 1.6-F Carnelian MARVELS S microcatheter (Tokai Medical Products, Aichi, Japan) was navigated to the occluded IPS. The LEONIS Mova successfully engaged the IPS, and its tip was fixed by adjusting the curve. The microcatheter advanced smoothly into the right CS. After releasing the fixation of the LEONIS Mova, the microcatheter was advanced further into the CS, where the LEONIS Mova was once again fixed. The microcatheter was easily navigated to the shunted pouch, and targeted coil embolization of the shunted pouch, achieving complete occlusion of the dural AVF.

Conclusion: The LEONIS Mova steerable catheter offers flexible angle adjustment and strong support for catheter navigation within an occluded IPS during TVE for CS-dural AVF.