Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients

Nelson, Peter Kim; Russell, Stephen; Woo, Henry H.; Alastra, Anthony; Vidovich, Danko

doi:10.3171/jns.2003.98.3.0498

Cited by 150 publications

(85 citation statements)

References 24 publications

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“…In the first 4 cases in this series, we used low concentration n-BCA under flow-arrest conditions to reach the shunt and to penetrate the origin of the draining vein, as has been well described in the literature. 13 With the use of Onyx embolic agent, we achieved anatomic cure in 4 patients by using transarterial Onyx embolization. This promising transarterial Onyx-based embolization of DAVFs involving the lesser sphenoid wing has been described in a case report.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Endovascular occlusion of these fistulous connections by transarterial or transvenous approaches is the primary therapeutic strategy for cure of these potentially dangerous lesions. Surgical disconnection of any recruited cortical draining veins may become necessary when embolization fails to eliminate the entire lesion.…”

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confidence: 99%

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Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations

Shi¹,

Ziegler²,

Feng³

et al. 2012

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations

Shi¹,

Ziegler²,

Feng³

et al. 2012

AJNR Am J Neuroradiol

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“…Careful consideration of the anatomy in each patient allowed cranial nerve complications to be avoided in our series. To achieve a higher cure rate, use of the wedged microcatheter technique with a low-concentration glue may also establish flow arrest conditions in which permeation of the glue into the venous drainage occurs by a controllable route 31,32 .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

et al. 2014

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“…These images were useful to determine the rate of flow through the fistula and proximity of the microcatheter tip, as well as the length of safety zone around the microcatheter for Onyx reflux. Ideally, the microcatheter tip would be wedged in the feeding artery providing superior control of forward flow of Onyx and reduced reflux, a technique which can also be used with nBCA injection 15 . The microcatheter was then flushed with heparinised normal saline.…”

Section: Methodsmentioning

confidence: 99%

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Chew

Weill

Guilbert

et al. 2009

Can. j. neurol. sci.

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Intracranial dural arteriovenous fistulas (DAVFs) are lesions with a heterogeneous clinical course, related to the varying patterns of venous drainage. Dural arteriovenous fistulas without cortical venous involvement tend to be relatively benign in course, while lesions with cortical venous drainage (whether direct or via reflux from dural venous sinuses) are more aggressive, having a higher rate of clinical presentation with aggressive neurological symptoms and intracranial haemorr-ABSTRACT: Purpose: To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx. Materials & Methods: Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months). Results: Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern. Chez un patient une embolisation additionnelle de n-butyl-2-cyanoacrylate (nBCA) a été effectuée au cours de la même session. Une imagerie a été obtenue chez tous les patients sauf un au cours du suivi (moyenne de 3,6 mois). Résultats : Nous avons obtenu un succès technique chez neuf patients à la fin de l'embolisation, avec exclusion angiographique complète de la fistule. Deux patients avaient une petite fistule résiduelle à la fin de l'embolisation, dont un présentait un léger drainage veineux cortical résiduel. Ces deux patients étaient stables à l'angiographie de suivi. Un patient avait une fistule résiduelle nourrie par l'artère ophtalmique dont l'embolisation a été jugée trop risquée. Il a été référé en chirurgie et l'intervention a été un succès. Chez un patient, le microcathéter s'est rompu et un fragment distal du microcathéter s'est logé dans l'artère occipitale. Il a été lai...

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Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients

Abstract: Transarterial NBCA embolization with the aid of a wedged catheter in flow-arrest conditions is a safe and an effective treatment for intracranial DAVFs.

Cited by 150 publications

References 24 publications

Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations

Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

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