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Objective: For transvenous embolization (TVE) of dural arteriovenous fistulae (dAVF) in the anterior condylar confluence (ACC), stable placement of a guiding catheter is important to approach the ACC from the jugular bulb (JB) with a microcatheter. We document our method and present a review of the literature. Case Presentations: We used a 5-Fr internal mammary artery (IMA) catheter to guide the microcatheter into the ACC for coil embolization. In one patient, we placed the steeply angled tip of a 5-Fr IMA catheter into the entrance of the ACC from the JB, guided the microcatheter into the ACC, and performed coil embolization. In another patient, we created a coaxial setup by inserting a 5-Fr IMA catheter into a 6-Fr guiding catheter and advanced the tip of the IMA catheter from the JB into the ACC entrance in accordance with the angulation of the ACC entrance. Conclusion: It is useful to select an IMA catheter based on anatomical structure when a direct approach from the JB to the ACC is required. Ours is the first report of an approach for TVE from the involved side using a guiding catheter adapted to the anatomical structure. We recommend the use of an IMA catheter adapted to the anatomical structures when a direct approach from the JB to the ACC is needed for TVE of dAVF in the ACC.

Selection of Guiding Catheter Based on the Anatomical Structures When Performing TVE to Treat an Anterior Condylar Confluence Dural AVF