Direct percutaneous transcarotid approach for embolization of dural sinus malformation in a premature neonate: A case report

Dural sinus malformations (DSM) can manifest with high output cardiac failure in neonates. Interventional procedures reduce the effect of shunting on cardiac function. The umbilical artery access (UA) is the preferred route in such cases, but it is not always available. Although transfemoral arterial access (TFA) is feasible, it can be associated with complications including limb ischemia in neonates with low birth weight (LBW) and small size. The Transcarotid arterial (TCAA) approach has been successfully used in pediatric cardiac interventions, however, its use in Pediatric Neurointervention is rare. We report antegrade percutaneous TCAA for embolization of DSM in a premature neonate with BW of 1710 grams and prenatal diagnosis of DSM who was delivered at 32 weeks due to worsening cardiac failure. Due to unavailable UA, embolization was performed via (TFA) at day 2, which was complicated by significant limb ischemia. Recurrent clinical deterioration warranted additional treatment, including 2 further embolizations which were performed via percutaneous TCAA of the left and right common carotid arteries at day 59 and 71 with no immediate or intermediate complications. Conclusions Direct percutaneous TCAA can be a feasible access for intracranial interventions in neonates with LBW and unavailable UA access.