scholarly journals Endovascular embolization for cases of ‘hidden’ pediatric cerebral arteriovenous malformations: A diagnostic & therapeutic challenge

2021 ◽  
pp. 106347
Author(s):  
Muhammad Arifin Parenrengi ◽  
Wihasto Suryaningtyas ◽  
Joandre Fauza
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Therapeutic Challenge

Morbidity and mortality associated with sequential flow reduction embolization technique of cerebral arteriovenous malformations using n-butyl cyanoacrylate

2020 ◽  
pp. neurintsurg-2020-016223
Author(s):  
Alfred P See ◽  
Mahmoud H Mohammaden ◽  
Mark Rizko ◽  
Christopher J Stapleton ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Morbidity And Mortality ◽  
Treatment Modalities ◽  
Cerebral Arteriovenous Malformations ◽  
Major Morbidity ◽  
Factors Affecting ◽  
Flow Reduction ◽  
Ruptured Avm ◽  
Targeting Strategy

BackgroundEndovascular embolization of cerebral arteriovenous malformations (AVM) with liquid n-butyl cyanoacrylate (n-BCA) serves multiple purposes including AVM occlusion and flow reduction in preparation for other treatment modalities. The objective was to study the clinical, structural, and angiographic factors affecting complications associated with AVM treatment by sequential n-BCA embolizations for nidal occlusion versus quantitative flow reduction in preparation for surgical resection or radiosurgery.MethodsWe performed a retrospective review of all patients who underwent endovascular embolization of cerebral AVM at our institution between 1998 and 2019, during which time the technique of traditional embolization evolved to a strategy of targeted sequential flow reduction guided by serial flow imaging based on quantitative magnetic resonance angiography, in conjunction with a shift away from nidal penetration.ResultsAmong 251 patients, 47.8% of patients presented with ruptured AVM. On average, each patient underwent 2.4 embolizations, for a total of 613 sessions. Major morbidity related to embolization occurred in 18 (7.2%) patients, but this occurred disproportionately in the traditional embolization strategy (n=16, 8%) in contrast with the flow-targeting strategy (n=2, 3.8%). Four patients (1.6%) died in the overall group, and these all occurred with the traditional embolization strategy (2% of 199 patients); no deaths occurred in the flow-targeting strategy (n=52).ConclusionEmbolization with n-BCA targeted to sequential flow reduction and feeder occlusion with limited nidal penetration prior to definitive surgical or radiosurgical treatment can be safely performed with low overall morbidity and mortality.

scholarly journals Outcome of Endovascular Treatment of Cerebral Arteriovenous Malformations with Ethylene Vinyl Alcohol Coploymer

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H E Mohram ◽  
M A Habib ◽  
S H Mourad ◽  
A H Abozeid ◽  
A M M Salem
Keyword(s):  
Arteriovenous Malformations ◽  
Interventional Procedures ◽  
Endovascular Embolization ◽  
Vascular Territory ◽  
Cure Rate ◽  
Cerebral Arteriovenous Malformations ◽  
University Hospitals ◽  
Curative Intent ◽  
Ethylene Vinyl Alcohol ◽  
Cerebral Avms

Abstract Background Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization. Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience. Objective The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery Patients and Methods This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro – endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017. Results Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years. Conclusion For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux up to 2–3 cm, with clear proximal parts of the draining veins, and not located in deep structures.

Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 611-621 ◽  
Author(s):  
Vernard S Fennell ◽  
Nikolay L Martirosyan ◽  
Gursant S Atwal ◽  
M Yashar S Kalani ◽  
Francisco A Ponce ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Cerebral Arteriovenous Malformations ◽  
Venous Outflow ◽  
Comprehensive Literature Review ◽  
Flow Through ◽  
Changes Over Time

Abstract The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.

Periprocedural intracranial hemorrhage after embolization of cerebral arteriovenous malformations: a meta-analysis

2020 ◽  
Vol 133 (5) ◽  
pp. 1417-1427 ◽  
Author(s):  
Yosuf W. Subat ◽  
Hormuzdiyar H. Dasenbrock ◽  
Bradley A. Gross ◽  
Nirav J. Patel ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Meta Analysis ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Curative Intent ◽  
Mortality And Morbidity ◽  
Ethylene Vinyl Alcohol ◽  
Procedural Complications ◽  
Hemorrhage Risk

OBJECTIVEThe primary goal of the treatment of cerebral arteriovenous malformations (AVMs) is angiographic occlusion to eliminate future hemorrhage risk. Although multimodal treatment is increasingly used for AVMs, periprocedural hemorrhage after transarterial embolization is a potential endovascular complication that is only partially understood and merits quantification.METHODSSearching the period between 1990 and 2019, the authors of this meta-analysis queried the PubMed and Embase databases for studies reporting periprocedural hemorrhage (within 30 days) after liquid embolization (using cyanoacrylate or ethylene vinyl alcohol copolymer) of AVMs. Random effects meta-analysis was used to evaluate the pooled rate of flow-related hemorrhage (those attributed to alterations in AVM dynamics), technical hemorrhage (those related to procedural complications), and total hemorrhage. Meta-regression was used to analyze the study-level predictors of hemorrhage, including patient age, Spetzler-Martin grade, hemorrhagic presentation, embolysate used, intent of treatment (adjuvant vs curative), associated aneurysms, endovascular angiographic obliteration, year of study publication, and years the procedures were performed.RESULTSA total of 98 studies with 8009 patients were included in this analysis, and the mean number of embolization sessions per patient was 1.9. The pooled flow-related and total periprocedural hemorrhage rates were 2.0% (95% CI 1.5%–2.4%) and 2.6% (95% CI 2.1%–3.0%) per procedure and 3.4% (95% CI 2.6%–4.2%) and 4.8% (95% CI 4.0%–5.6%) per patient, respectively. The mortality and morbidity rates associated with hemorrhage were 14.6% and 45.1%, respectively. Subgroup analyses revealed a pooled total hemorrhage rate per procedure of 1.8% (95% CI 1.0%–2.5%) for adjuvant (surgery or radiosurgery) and 4.6% (95% CI 2.8%–6.4%) for curative intent. The treatment of aneurysms (p = 0.04) and larger patient populations (p < 0.001) were significant predictors of a lower hemorrhage rate, whereas curative intent (p = 0.04), angiographic obliteration achieved endovascularly (p = 0.003), and a greater number of embolization sessions (p = 0.03) were significant predictors of a higher hemorrhage rate. There were no significant differences in periprocedural hemorrhage rates according to the years evaluated or the embolysate utilized.CONCLUSIONSIn this study-level meta-analysis, periprocedural hemorrhage was seen after 2.6% of transarterial embolization procedures for cerebral AVMs. The adjuvant use of endovascular embolization, including in the treatment of associated aneurysms and in the presurgical or preradiosurgical setting, was a study-level predictor of significantly lower hemorrhage rates, whereas more aggressive embolization involving curative intent and endovascular angiographic obliteration was a predictor of a significantly higher total hemorrhage rate.

Adenosine-induced Ventricular Asystole to Induce Transient Profound Systemic Hypotension in Patients Undergoing Endovascular Therapy

2000 ◽  
Vol 93 (4) ◽  
pp. 998-1001 ◽  
Author(s):  
Tomoki Hashimoto ◽  
William L. Young ◽  
Beverly D. Aagaard ◽  
Shailendra Joshi ◽  
Noeleen D. Ostapkovich ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Dose Response ◽  
Arteriovenous Malformations ◽  
Dose Range ◽  
Endovascular Embolization ◽  
Constant Infusion ◽  
Cerebral Arteriovenous Malformations ◽  
Systemic Hypotension ◽  
Response Characteristics ◽  
Profound Hypotension

Background Adenosine-induced asystole has been used to induce transient systemic hypotension for various vascular procedures. Dose-response characteristics of adenosine-induced ventricular asystole have not been determined. Methods During endovascular embolization of cerebral arteriovenous malformations, the authors performed a series of adenosine test injections to establish a dose-response relation in each patient. After an interval of 3-10 min, the dose was escalated by 10-20 mg for each injection to achieve an end point of 20-30 s of stable mean arterial pressure (MAP) reduction to 25-30 mmHg. All patients received constant infusion of nitroprusside (approximately 1 microgram. kg-1. min-1) throughout the procedure. Results The authors studied four adult patients (age, 22-44 yr; two patients had two separate procedures) and one pediatric patient (age, 4 yr). Twenty-three adenosine injections resulted in measurable asystole. The adenosine dose was 0. 98 +/- 0.40 mg/kg (mean +/- SD), and the dose range was 0.24-1.76 mg/kg (6-90 mg). The duration of asystole, MAP &lt; 30 mmHg, and MAP &lt; 50 mmHg, were 8 +/- 3 s, 18 +/- 12 s, and 50 +/- 29 s, respectively. The minimum MAP and the MAP for the first 20 s were 16 +/- 3 mmHg and 30 +/- 9 mmHg, respectively. There was a linear relation between adenosine dose and the duration of hypotension with MAP &lt; 30 mmHg and MAP &lt; 50 mmHg. Conclusions In the dose range studied, a series of adenosine test injections can be used to determine optimal adenosine dose for induction of transient profound hypotension.

Curing arteriovenous malformations using embolization

2014 ◽  
Vol 37 (3) ◽  
pp. E19 ◽  
Author(s):  
Matthew B. Potts ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Peter K. Nelson ◽  
Howard A. Riina
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Curative Intent ◽  
The Past ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Diagnostic Angiography ◽  
Endovascular Technology

Endovascular embolization is typically reserved as an adjuvant therapy in the management of cerebral arteriovenous malformations (AVMs), either for preoperative devascularization or preradiosurgical volume reduction. Curative embolization plays a limited role in AVM treatment but several studies have shown that it is possible, especially with later-generation liquid embolic agents. Given the complexity of AVM anatomy and the recent controversies over the role of any intervention in AVM management, it is critical that the cerebrovascular community better define the indications of each treatment modality to provide quality AVM management. In this review, the authors evaluate the role of curative AVM embolization. Important considerations in the feasibility of curative AVM embolization include whether it can be performed reliably and safely, and whether it is a durable cure. Studies over the past 20 years have begun to define the anatomical factors that are amenable to complete endovascular occlusion, including size, feeding artery anatomy, AVM morphology, and endovascular accessibility. More recent studies have shown that highly selected patients with AVMs can be treated with curative intent, leading to occlusion rates as high as 100% of such prospectively identified lesions with minimal morbidity. Advances in endovascular technology and techniques that support the efficacy and safety of curative embolization are discussed, as is the importance of superselective diagnostic angiography. Finally, the durability of curative embolization is analyzed. Overall, while still unproven, endovascular embolization has the potential to be a safe, effective, and durable curative treatment for select AVMs, broadening the armamentarium with which one can treat this disease.

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