Endovascular Treatment of Vascular Malformation: An Overview

Superselective intranidal delivery of platinum-based high-density packing coils for treatment of arteriovenous malformations

“…8 Classification schemes, such as those championed by Yakes and Houdart, therefore, remain essential component of therapeutic strategies ( Table ). 9 , 10 It is essential to highlight that superselective, third and fourth order, branch microcatheterization is needed—with microcatheters as low profile as 1.6F—for adequate terminal access of the nidus such that premature and proximal nontarget embolization is avoided. With certain anatomic constraints, however, in which direct intranidal microcatheter access might not be feasible or safe, these “liquid metal” coils can be advanced antegradely to penetrate the nidus from a more proximal location, given their low resistance to flow and premature coiling on exiting from the microcatheter tip.…”

“…These maneuvers are not possible with liquid embolic agents, which can have catastrophic—even lethal—consequences. 5 Furthermore, the inert, noninflammatory nature of platinum is beneficial for subsequent surgical debulking or resection of the treated AVM. We have used Doppler ultrasound studies for follow-up imaging, because the presence of coils results in prohibitive artifacts on computed tomography or MRI.…”

“…These can be associated with potentially devastating complications related to nontarget distribution and embolization, especially in less experienced hands. 5 Although coils have been used to obliterate direct fistulous arteriovenous connections and as adjunct embolic agents to seal proximal nidus arterial feeders and distal venous drainers, coiling has not been used routinely for intranidal embolization owing to the technical limitations and the coils' inability to induce endothelial cell disruption. In the present report, we have demonstrated that superselective intranidal embolization using the latest generation, platinum-based packing coils as a first-line embolic agent is safe and effective in treating certain configurations of AVMs.…”

Polymerisation of cyanoacrylates: The effect of sclero-embolic and contrast agents

“…n-Butyl cyanoacrylates (n-BCAs) are used in cyanoacrylate adhesive closure (CAC) procedures to treat superficial veins, in interventional radiology to treat vascular anomalies and in gastric surgery to treat gastric varices. [1][2][3][4][5] There have been significant developments and advancements in the Interventional Neuroradiology (INR) speciality over the past five decades. Kerber et al were the first to describe super-selective embolisation of intracranial vascular anomalies using a novel method involving isobutyl cyanoacrylate and a calibrated leak balloon system as early as 1978, 6 and Professor Kerber was the first to perform a carotid angioplasty in 1979.…”

Study of Safety and Efficacy of Endovascular Management of High-Flow Arteriovenous Malformation

“…Vascular malformations provide one of the most pressing challenges in contemporary medicine due to the complexity of both diagnosis and treatment (1) . There are two types of vascular malformations; highflow and low-flow.…”