Embolization of Cerebral Arteriovenous Malformations: Part I-Technique, Morphology, and Complications

Wikholm, Gunnar; Lundqvist, Christer; Svendsen, P.

doi:10.1227/00006123-199609000-00004

Cited by 100 publications

(23 citation statements)

References 28 publications

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“…Most reported complete embolization rates are ϳ10% when using n-BCA as the main embolic material. [1][2][3][4][5][6][7][8][9] The exceptionally high occlusion rate of 40% reported by Valavanis and Yaşargil 10 is noteworthy. Recently, a new embolic agent Onyx (ev3, Irvine, California) composed of ethylene-vinyl alcohol dissolved in DMSO was approved for neuroendovascular treatment.…”

mentioning

confidence: 87%

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

Maimon¹,

Strauss²,

Frolov³

et al. 2010

AJNR Am J Neuroradiol

109

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BACKGROUND AND PURPOSE: Endovascular embolization with Onyx is one of the tools used in the treatment of intracerebral AVMs. The recent introduction of a new microcatheter with detachable tip has led us to adopt a new treatment approach by using endovascular embolization with Onyx as the main treatment for brain AVM with curative intent. The purpose of the present study is to evaluate our initial results by using this new treatment strategy with special emphasis on the safety and feasibility of the technique.

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mentioning

confidence: 87%

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

Maimon¹,

Strauss²,

Frolov³

et al. 2010

AJNR Am J Neuroradiol

109

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“…For instance, the discovery of a transcatheter mean arterial feeder pressure Ͼ40 mm Hg below the mean systemic blood pressure is in itself highly indicative of the presence of a downstream intranidal fistula. 42 Once a fistula is discovered after superselective angiography and hemodynamic assessment, it may be necessary to occlude it endovascularly (eg, under systemic hypotension, to reduce the possibility of rupture during the procedure 43 ) before radiosurgery. It is speculated that future adoption of these measures may allow a more precise and objective means of selecting/screening those AVMs that are hemodynamically amenable to safe and effective radiosurgical treatment and may perhaps help in reducing the hemorrhage rates in those AVMs that are partially irradiated or those that are completely irradiated (such as some larger AVMs or those in older patients 8 ).…”

Section: Intranidal Hemodynamic Changes After Avm Radiosurgerymentioning

confidence: 99%

Experimental Radiosurgery Simulations Using a Theoretical Model of Cerebral Arteriovenous Malformations

Massoud

Hádemenos

Salles

et al. 2000

Stroke

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Background and Purpose-A novel biomathematical arteriovenous malformation (AVM) model based on electric network analysis was used to investigate theoretically the potential role of intranidal hemodynamic perturbations in elevating the risk of rupture after simulated brain AVM radiosurgery. Methods-The effects of radiation on 28 interconnected plexiform and fistulous AVM nidus vessels were simulated by predefined random or stepwise occlusion. Electric circuit analysis revealed the changes in intranidal flow, pressure, and risk of rupture at intervals of 3 months during a 3-year latency period after simulated partial/complete irradiation of the nidus using doses Ͻ25 and Ն25 Gy. An expression for risk of rupture was derived on the basis of the functional distribution of the critical radii of component vessels. The theoretical effects of radiation were also tested on AVM nidus vessels with progressively increasing elastic modulus (E) and wall thickness during the latency period, simulating their eventual fibrosis. Results-In an AVM with Eϭ5.0ϫ104 dyne/cm 2 , 4 (14.3%) of a total 28 sets of AVM radiosurgery simulations revealed theoretical nidus rupture (risk of rupture Ն100%). Three of these were associated with partial nidus coverage and 1 with complete treatment. All ruptures occurred after random occlusion of nidus vessels in AVMs receiving low-dose radiosurgery. Intranidal hemodynamic perturbations were observed in all cases of AVM rupture; the occlusion of a fistulous component resulted in intranidal rerouting of flow and escalation of the intravascular pressure in adjacent plexiform components. Risk of rupture was found to correlate with nidus vessel wall strength: a low E of 1.9ϫ10

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“…8,9,11,25 Nevertheless Valavanis and Christoforidis 26 identified direct or dominant feeding arteries, a monocompartmental nidus, and a dominant fistulous component of the nidus without perinidal angiogenesis as predictive characteristics of angiographic cure with n-BCA, whereas the AVM size or the number of feeding pedicles was not found to be a determinant predictive factor for complete endovascular occlusion. AVM characteristics reported to be associated with higher occlusion rates after Onyx embolization are a supratentorial and cortical location, a compact and plexiform nidus, a small number of supplying (direct) feeders, and 1 superficial draining vein.…”

Section: Discussionmentioning

confidence: 99%

Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx)

Panagiotopoulos¹,

Gizewski²,

Asgari³

et al. 2008

AJNR Am J Neuroradiol

200

108

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Embolization of Cerebral Arteriovenous Malformations: Part I-Technique, Morphology, and Complications

Cited by 100 publications

References 28 publications

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

Experimental Radiosurgery Simulations Using a Theoretical Model of Cerebral Arteriovenous Malformations

Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx)

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