A safe and efficacious alternative: sonographically guided internal jugular vein puncture for intracranial endovascular intervention

Abstract

Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.

Fig 1.

A 61-year-old woman with a right sigmoid sinus DAVF. A, Right internal carotid artery angiogram in an anteroposterior projection shows early opacification of the right sigmoid sinus and internal jugular vein with retrograde venous drainage through cerebral vein. B and C, After venous sheaths are placed in the bilateral internal jugular veins, trapping of the right sigmoid sinus is performed with a vascular plug (through the right internal jugular vein) and 28 GDCs (through the left internal jugular vein access). D, The fistula is completely obliterated after embolization.

Fig 2.

A 63-year-old man with a left indirect CCF. A, Left ICA angiogram in a lateral projection shows early opacification of the cavernous sinus with venous drainage mainly through the left superior ophthalmic vein. B and C, After a 6F sheath is placed into the left internal jugular vein (B), a microcatheter is navigated through the left facial vein, left angular vein, and left superior ophthalmic vein into the left cavernous sinus (C). After 16 GDCs were deployed, the left cavernous sinus was completely occluded without residual fistula.

Fig 3.

A 53-year-old man with bilateral indirect CCFs. A and B, Left ICA angiogram in lateral (A) and anteroposterior (B) projections shows early opacification of bilateral cavernous sinuses with venous drainage through the bilateral superior ophthalmic vein. C, After the venous access is established, a microcatheter is navigated through the right facial vein, right superior ophthalmic vein, right cavernous sinus, and left cavernous sinus and into the left superior ophthalmic vein. Then embolization of bilateral superior ophthalmic veins and cavernous sinuses is performed with 31 GDCs. D, No residual fistula is seen on the postembolization angiogram.

Fig 4.

A 54-year-old woman with superior sagittal sinus thrombosis. A and B, Left internal carotid artery angiogram, venous phase, in anteroposterior (A) and lateral (B) projections shows occlusion of superior sagittal sinus, right transverse sinus, right sigmoid sinus, and left transverse sinus (not shown). C, After a 6F guiding catheter is placed into the superior sagittal sinus, angioplasty with a balloon catheter is performed. D, After subsequent 48-hour chemical thrombolysis with urokinase, recanalization of the superior sagittal sinus and left transvenous sinus is confirmed in MR venography 3 days and 6 months later (not shown).