Adjuvant Embolization With N -Butyl Cyanoacrylate in the Treatment of Cerebral Arteriovenous Malformations

Abstract

Background and Purpose-The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. Methods-From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (nϭ176) or radiosurgery (nϭ26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4Ϯ34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale Յ2), or significant (modified Rankin Scale Ͼ2). Results-Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (PϽ0.0001). Five patients had persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95% CI, 1.4 to 8.6), diameter Ͻ3 cm (OR, 3.2; 95% CI, 1.2 to 9.1), diameter Ͼ6 cm (OR, 6.2; 95% CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95% CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95% CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (PϽ0.0001). Conclusions-Small

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…The combined use of NBCA and other embolic materials has the advantage of preventing excessive embolization and shortening the procedure time [72,120,151,171,179].…”

Predictors of Hemorrhagic Complications from Endovascular Treatment of Cerebral Arteriovenous Malformations

“…However, modest attention has been paid in the literature to the predictive factors of this complication, whereas many studies have addressed the predictors of neurological deficit. The rates of hemorrhagic complications associated with embolization involve 1.6-15% of patients, and 0.6-5.6% of procedures 3,9,12,[14][15][16][17][18][19][20][21][22][23][24][25] , while complications reported in large series are only 1.6-3.1% for patients 12,21,23 . Among the mechanisms described as causing these complications are hemodynamic changes, the occlusion of drainage veins and specific morphological characteristics.…”

Experimental study of temperature-sensitive chitosan/β-glycerophosphate embolic material in embolizing the basicranial rete mirabile in swines

“…In addition, adhesive liquid embolic materials (15)(16)(17)(18), including cyano acid isobutyl fatty acid and its derivatives, are most commonly used in clinical practice. However, their limitations include adhering easily to the high-molecular microcatheter, which subsequently blocks the catheter.…”