{
  "abstract": "Background Unlike arteries, the major dural venous sinuses contain intraluminal septa, fibrous bands, arachnoid granulations, and irregular geometries. The real-time mechanical interaction between these structures and contemporary endovascular devices remains poorly characterized. We aimed to directly visualize and categorize device-anatomy interactions within the dural venous sinuses using a perfused human cadaveric angioscopy model.Methods Six fresh human head-and-neck cadaveric specimens were prepared for the device testing. Bilateral internal jugular veins were cannulated and perfused with warmed saline (35-37°C) using a peristaltic pump to generate continuous flow and physiologic sinus distension (4-6 cm H 2O). Direct intraluminal angioscopy was achieved via burr hole access to the superior sagittal sinus, with visualization extended to the posterior superior sagittal and bilateral transverse sinuses. Under continuous perfusion standard venous neurointerventional maneuvers were performed. All procedures were recorded and independently reviewed to identify reproducible mechanisms of technical challenge and device failure.Results Angioscopy identified four principal mechanisms of device-anatomy interaction. (1) Parallel-channel catheterization: Intraluminal bands and septations frequently created secondary channels parallel to the primary sinus lumen. Guidewires advanced smoothly; however, catheter advancement stalled due to friction or ledge engagement, sometimes resulting in complete arrest. Deployment of stent retrievers or venous stents within these restricted channels led to constrained and asymmetric expansion. (2) Constrained device expansion: Intraluminal septa produced focal compression of deployed stents, resulting in incomplete wall apposition and, in some cases, persistent kinking despite satisfactory fluoroscopic appearance. (3) Balloon-band interaction: With semi-compliant balloons, intraluminal bands stretched during inflation but recoiled to baseline after deflation, consistent with elastic resistance rather than permanent remodeling. Compliant balloons demonstrated persistent waist formation at firm bands, assuming an hourglass configuration despite full inflation pressures and sinus wall apposition, without structural disruption of the bands. In contrast, cutting balloons produced focal band transection, representing true structural modification. (4) Arachnoid granulation interaction: Aspiration mobilized adjacent granulations into the catheter inlet, causing transient occlusion. Balloon compression flattened granulations against the sinus wall, with incomplete return to baseline configuration after deflation.Conclusions The dural venous sinuses contain intrinsic anatomical constraints that directly influence endovascular device performance. Arterial-derived devices demonstrate reproducible but underrecognized failure modes in the venous environment, including parallel-channel navigation, constrained device expansion, deformation, and aspiration inlet obstruction. A perfused cadaveric angioscopy platform enables direct mechanistic evaluation of these interactions and provides a translational framework for venous-specific device design and procedural optimization.Disclosures Y. Senol: None. N. Krishnan: None. N. Krishnan: None. B. Cho: None. P. Kumar: None. A. Haider: None. P. Pardalidis: None. D. Leong: None.Abstract O-050 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "Y Senol"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "N Krishnan"
    },
    {
      "affiliations": [
        "UCLA, Los Angeles, CA"
      ],
      "name": "A Liu"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "N Krishnan"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "B Cho"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "P Kumar"
    },
    {
      "affiliations": [
        "Radiology, University of California San Franciso, San Francisco, CA"
      ],
      "name": "A Haider"
    },
    {
      "affiliations": [
        "Radiology, University of California San Franciso, San Francisco, CA"
      ],
      "name": "P Pardalidis"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Franciso, San Francisco, CA"
      ],
      "name": "D Leong"
    },
    {
      "affiliations": [
        "Radiology, UCSF, San Francisco, CA"
      ],
      "name": "M Amans"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Francisco, San Francisco, CA"
      ],
      "name": "L Savastano"
    }
  ],
  "title": "O-050 Angioscopic insights into endovascular device-anatomy interactions within the dural venous sinuses",
  "uid": "db813e27-df72-5cdd-85d3-fcd8eaa4b2d0"
}