What you see is what you hear: microangioscopy-guided management of carotid-cochlear dehiscence in pulsatile tinnitus.

Angioscopy is an emerging technology in neurointervention.1-4 The Vena MicroAngioscope (MA) is a sterile, single-use, full-color, forward-viewing angioscope delivered through a guiding or distal access catheter, with or without flow arrest, and saline irrigation. The device is 160 cm in length, with a 3 Fr distal radiopaque tip, and connects to the Vena Camera Control Unit for illumination and real-time image capture (see video 1). We present a video demonstrating the second-generation MA used with the SmartGUIDE deflectable tip guidewire in treating a carotid-cochlear dehiscence causing pulsatile tinnitus.5 A 45-year-old man underwent balloon occlusion testing confirming symptom origin, followed by BeGraft covered stent placement. The MA demonstrated intraluminal vascular indentation consistent with the underlying bony defect. Post-deployment angioscopy confirmed complete defect coverage, optimal wall apposition, and absence of thrombus, while detecting subtle iatrogenic endothelial injury that was undetectable by angiography, underscoring its value for intraprocedural vessel wall assessment.-neurintsurg;jnis-2026-025020v1/V1F1V1Video 1 .