C83 From cognitive collapse to flow restored: stenting, coiling, and liquid embolisation in dual davfs with sinus thrombosis

<h3>Introduction</h3> Dural arteriovenous fistulas (DAVFs) in the context of cerebral venous sinus thrombosis represent a critical threat when combined with cortical venous reflux. Treatment aims to restore physiological venous outflow and eliminate fistulous drainage while avoiding compromise of major sinuses. <h3>Case Description</h3> A 70-year-old male presented with acute neurological deficits and subacute major cognitive decline. Imaging revealed extensive thrombosis of the superior sagittal and bilateral transverse sinuses. MRI showed oedema in the deep brain structures and cerebellar peduncles. Angiography confirmed two high-grade DAVFs: one at the torcula and one at the vertex, both with massive cortical reflux. A staged treatment strategy was employed. First, the right transverse sinus was recanalised and a torcula DAVF was treated via transvenous embolisation. A common arterial collector was identified and occluded using detachable coils (via an Echelon-10), followed by stent reconstruction with a 10×40 mm Precise stent to reinforce venous outflow. In the second procedure, the vertex DAVF was treated transarterially. With the superior sagittal sinus occluded, selective catheterisation of the middle meningeal artery branches enabled embolisation using 20% NBCA and Squid 12 via a Magic 1.2FM microcatheter. <h3>Conclusions</h3> This case illustrates the value of a staged, anatomically tailored approach in treating multiple DAVFs within a thrombosed venous system. Recanalisation and reconstruction of venous outflow, combined with targeted embolisation via both venous and arterial routes, led to resolution of cortical reflux and rapid neurological recovery. Identifying a common collector enabled a focused, low-risk ‘magic bullet’ cure. <h3>Conflict of Interest</h3> No