C76 Target locked: the magic bullet approach to sigmoid sinus fistula embolization with a steerable microcatheter

<h3>Introduction</h3> Selective transvenous embolisation is the gold standard for curative treatment of dural arteriovenous fistulas (dAVFs) when preserving the function of adjacent dural sinuses is essential. Achieving access to the parasinusal venous pouch is often the limiting factor in targeting the true shunt zone. Steerable microcatheters now offer a means to reach these regions with unprecedented precision. <h3>Case Description</h3> A patient with a left-sided Cognard IIa sigmoid sinus dAVF presented with disabling pulsatile tinnitus. Initial treatment had been deferred due to the proximity of the shunt to the drainage of the vein of Labbé. Follow-up angiography demonstrated fistula progression but with favourable separation of the venous pouch from functional outflow. Through a transjugular approach, a SwiftNINJA 21 steerable microcatheter was used to navigate retrogradely into the parasinusal recipient vein. Coiling was performed under balloon assistance (Copernic RC). Contralateral access allowed additional rostral feeder occlusion. Venous pressure dropped from 16–18 mmHg pre-embolisation to 5–6 mmHg post-procedure. Final angiographic control confirmed complete occlusion of the fistula with preserved patency of the sigmoid sinus and vein of Labbé. The patient’s tinnitus resolved completely, and no complications occurred. <h3>Conclusions</h3> This case demonstrates that selective parasinusal embolisation using a steerable catheter can achieve a ‘magic bullet’ cure in dAVF treatment: full occlusion of the pathological venous recipient without jeopardising physiological sinus drainage. Steerable technology extends the reach of transvenous embolisation and enhances safety in complex cases. <h3>Conflict of Interest</h3> No