Endovascular Treatment of Deep Hemorrhagic Brain Arteriovenous Malformations with Transvenous Onyx Embolization

Consoli, Arturo; Renieri, Leonardo; Nappini, Sergio; Limbucci, Nicola; Mangiafico, Salvatore

doi:10.3174/ajnr.a3497

Cited by 59 publications

(38 citation statements)

References 12 publications

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“…To the best of our knowledge, apart from very few case reports, 1,15 this is the first case series of brain AVM treatment via a transvenous endovascular approach. Although in the past transvenous endovascular techniques were con- sidered risky, 5,13 the concept of venous side occlusion for permanent AVM cure has been around for 2 decades.…”

Section: Discussionmentioning

confidence: 99%

Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

Iosif¹,

Mendes²,

Saleme³

et al. 2015

JNS

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OBJECT Ruptured cerebral arteriovenous malformations (AVMs) with deep localization and high Spetzler-Martin grades are associated with considerable challenges regarding nidus eradication treatment. The authors report their experience with curative endovascular transvenous embolization in a series of patients harboring “untreatable” lesions. METHODS Between January 2008 and June 2013, a transvenous endovascular embolization protocol was implemented at the authors' institution for consecutive patients with ruptured brain AVMs that were considered incurable by classic endovascular and surgical techniques. Therapeutic decision making was based on Spetzler-Martin grades, AVM location, type of venous drainage, and angioarchitectural evaluation. Complete exclusion of the nidus was the objective of treatment. RESULTS Twenty patients (10 male and 10 female, mean age 36.7 ± 17.7 years) were included. Initial Spetzler-Martin grades were III–V for 90.0% of the patients. The lesions were deeply seated in 80% and in eloquent locations in 90% of cases. The preprocedural modified Rankin Scale score was 0–2 for 12 of the 20 patients (60.0%), 3 for 2 patients (10.0%), and 4 for 6 patients (30.0%). The postprocedural clinical status was unchanged for all patients. The procedure was technically feasible in all cases. Procedure-related mortality was 0%. Ninety percent of the patients were independent in their everyday lives (modified Rankin Scale Scores 0–2) at the 6-month follow-up. In all cases but one (95%) the embolization was curative, confirmed by selective DSA at 6 months and 18 months postintervention. CONCLUSIONS Single-session endovascular transvenous embolization seems to be a safe and effective curative treatment for patients harboring complex brain AVMs with high Spetzler-Martin grade.

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Section: Discussionmentioning

confidence: 99%

Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

Iosif¹,

Mendes²,

Saleme³

et al. 2015

JNS

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“…1,5,9,11,12,16 In some instances, especially in the deepest portion of the AVM, recurrent configuration and unfavorable angled loops at the origin of the feeders lead to unstable micro- catheter navigation. 7,9,15 Attempts to gain distal access result in prolapse of the system into the parent vessel. 19 The struggling microcatheter navigation usually requires multiple attempts and excessive wire exchanges, leading to distal wire perforation in more than 3% of cases 2 and death in up to 4.6% of patients.…”

Section: Discussionmentioning

confidence: 99%

Balloon-assisted microcatheter navigation for AVM embolization: technical note

Mendes¹,

Silveira²,

Saleme³

et al. 2015

JNS

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Recurrent feeders may preclude a successful arterial catheterization of arteriovenous malformations (AVMs). In this paper, the authors report their experience with the use of a compliant balloon to assist the microcatheter navigation in AVMs supplied by feeders with recurrent configuration. Eight patients with AVMs supplied by recurrent feeders had unsuccessful microcatheter navigation after multiple attempts to catheterize the pedicle. A compliant balloon was inflated in the parent artery immediately after the origin of the feeder. The microcatheter was then advanced over the wire while the balloon provided support for the navigation. Distal access close to the nidus was achieved in all cases. Anatomical cure was documented in 75% cases. There were no arterial perforations or thromboembolic events. The described technique is a straightforward method for providing support to microcatheter navigation in certain cases of cerebral AVMs supplied by recurrent arterial feeders. This simple yet effective maneuver may enhance outcomes of AVM embolization by eliminating the need for excessive attempts of catheterization.

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“…This embolic agent laminates along the venous wall without causing immediate vessel occlusion and penetrates to the nidus in a centrifugal manner. 7,20 In this series, the TVA was not considered first-line treatment for cerebral AVMs. This endovascular technique was performed in complex lesions that were considered high risk for microsurgery.…”

Section: Endovascular Therapy In Childrenmentioning

confidence: 97%

“…3 Excessive attempts to catheterize these vessels increase the risk of rupture and/or dissection. 20 In such instances, the use of the venous approach is the only endovascular option to treat these lesions using nonadhesive liquids. Contemporary literature in pediatric AVM embolization demonstrates low rates (21.2%) of anatomic exclusion with risks of complications in up to 7.3% of cases.…”

Section: Endovascular Therapy In Childrenmentioning

confidence: 99%