Improved Image Interpretation With Combined Superselective and Standard Angiography (Double Injection Technique) During Embolization of Arteriovenous Malformations

Yao, Tom L; Eskioglu, Eric; Ayad, Michael; Ulm, Arthur J.; Mericle, Robert A.

doi:10.1227/01.neu.0000317384.53314.f2

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…Additionally, all of the remaining patients without recurrence had an embolic cast that looked similar in morphology to the nidus, indicating no portions of the nidus were untreated. We believe the best method to predict recurrence after complete angiographic obliteration of an AVM is to draw a perimeter line around the nidus with a dry erase marker and observe opacification of the area inside the perimeter with embolic agent, as previously described 33. This study does not address all of the possible factors leading to angiographic obliteration or recurrence and it is likely that other predictors exist.…”

Section: Discussionmentioning

confidence: 95%

Complete angiographic obliteration of intracranial AVMs with endovascular embolization: incomplete embolic nidal opacification is associated with AVM recurrence

Reig

Rajaram

Simon³

et al. 2010

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 95%

Complete angiographic obliteration of intracranial AVMs with endovascular embolization: incomplete embolic nidal opacification is associated with AVM recurrence

Reig

Rajaram

Simon³

et al. 2010

J NeuroIntervent Surg

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“…Dual injection simultaneous digital subtraction angiographies, roadmaps, and 3-dimensional angiography are invaluable for visualizing the entirety of the “route” of navigation. 41,63-65…”

Section: Discussionmentioning

confidence: 99%

“…Dual injection simultaneous digital subtraction angiographies, roadmaps, and 3-dimensional angiography are invaluable for visualizing the entirety of the "route" of navigation. 41,[63][64][65] Injury to the Pcomm or Acomm can potentially result in damage to perforators with significant clinical consequences, [66][67][68][69] and changes in vessel configuration created during transcirculation interventions can potentially increase the risks of direct injury.…”

Section: Discussionmentioning

confidence: 99%

The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach

Colasurdo

Edhayan

Taweel

et al. 2022

Operative Neurosurgery

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BACKGROUND:With the development of advanced endovascular techniques and materials, neurointerventionalists can perform challenging and complex cases that were previously difficult to perform. Transcirculation approaches could be a useful tool used in complicated cases, providing access to the target vessel, through the contralateral or opposite circulation, when anterograde access is difficult or nonachievable.OBJECTIVE:To retrospectively review cerebrovascular interventions performed through a transcirculation approach performed by staff at our Institution.METHODS:English-language studies, published until August 2022, reporting transcirculation interventions in the cerebrovascular circulation were retrospectively collected. Type of intervention, number of cases, rationale, and complications were analyzed. Furthermore, similar cases performed by staff currently at our institution were also reviewed and described.RESULTS:Including our cases, a total of 273 transcirculation treatment approaches have been reported. Intracranial aneurysm embolization, stroke thrombectomies, intra-arterial ophthalmic chemotherapy, arteriovenous malformationss, arteriovenous fistulas embolizations, and intracranial angioplasty and stenting are common indications. Reason for using a retrograde approach were stent/balloon–assisted coiling of wide neck aneurysm in 116 cases, difficult angulation of branch in 91 cases, occlusion of parent vessel in 55 cases, and bailout/other in 11 cases.CONCLUSION:Transcirculation approaches can be considered for cases where conventional anterograde treatment options are not feasible or as a bailout strategy in failed or complicated treatment attempts. They represent a strategy to consider when facing challenging cases, and if performed by experienced and dedicated neurointerventionalists, they can represent a safe alternative.

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“…The interest in superselective catheterization for the description of AVM compartments, or to be overlaid with more global angiography, is well known. 13 19 Many authors, including Yasargil, Lo, Yamada, and Kakizawa, 13–17 have given descriptions of compartments in the nidus of the AVM. Yao et al 19 have described the advantages of a technique of superselective injection superimposed with the guiding catheter injection simultaneously in the same run to improve visualization of the angioarchitecture of the nidus.…”

Section: Discussionmentioning

confidence: 99%

“…During EVT of brain AVMs, superselective catheterization and angiography of the arterial feeders of the AVM are routinely performed before embolization. 18 Yao et al 19 have described a technique of superselective injection superimposed on the global angiogram to improve visualization of the angioarchitecture of the nidus. As three-dimensional (3D) MR offers crucial anatomical landmarks, having the possibility of precisely matching those complementary modalities, it is likely to improve our analysis of AVMs prior to treatment.…”

Section: Introductionmentioning

confidence: 99%

Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study

Blanc

Seiler

Robert

et al. 2014

J NeuroIntervent Surg

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PurposeWe describe our protocol of three-dimensional (3D) Roadmap intracranial navigation and image fusion for analysis of the angioarchitecture and endovascular treatment of brain arteriovenous malformations (AVMs).MethodsWe performed superselective catheterization of brain AVMs feeders under 3D-Roadmap navigation. Angiograms of each catheterized artery on two registered orthogonal views were transferred to the imaging workstations, and dedicated postprocessing imaging software allowed automated multiple overlays of the arterial supply of the AVM superselective acquisitions on the global angiogram in angiographic or 3D views and on coregistered MRI datasets.Results11 untreated brain AVMs (4 with hemorrhagic presentation) were explored. The superselective acquisitions were performed under 3D-Roadmap navigation in 74 arteries, for a total of 79 targeted arteries. Imaging analysis was available at table side or postoperatively for discussion of the therapeutic strategy. No complications occurred during superselective catheterization. The accuracy of the coregistration of angiogram and MRI was submillimetric after automated mutual information coregistration, with manual re-registration by the physicians.ConclusionsSuperselective angiograms acquired under 3D-Roadmap navigation can be postprocessed with multiple overlays. The fluoroscopic navigation under 3D-Roadmapping and the coregistration of 3D rotational angiography, selective angiography, and 3D MR datasets appears reliable with millimeter accuracy, and could be implemented in the critical brain AVM embolization setting to allow refined analysis of AVM angioarchitecture.

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Improved Image Interpretation With Combined Superselective and Standard Angiography (Double Injection Technique) During Embolization of Arteriovenous Malformations

Abstract: The double injection technique, with marking pen demarcation of the nidus perimeter, venous drainage, and microcatheter tip position, was qualitatively useful in every case.

Cited by 4 publications

References 3 publications

Complete angiographic obliteration of intracranial AVMs with endovascular embolization: incomplete embolic nidal opacification is associated with AVM recurrence

Complete angiographic obliteration of intracranial AVMs with endovascular embolization: incomplete embolic nidal opacification is associated with AVM recurrence

The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach

Multimodal angiographic assessment of cerebral arteriovenous malformations: a pilot study

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