Complete flow control using transient concurrent rapid ventricular pacing or intravenous adenosine and afferent arterial balloon occlusion during transvenous embolization of cerebral arteriovenous malformations: case series

2021 ◽  
Vol 13 (4) ◽  
pp. 324-330
Author(s):  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Kunal Vakharia ◽  
Hamid H Rai ◽  
Felix Chin ◽  
...  
Keyword(s):  
Flow Control ◽  
Arteriovenous Malformations ◽  
Case Series ◽  
Balloon Occlusion ◽  
The Other ◽  
Transvenous Embolization ◽  
Ventricular Pacing ◽  
Cerebral Arteriovenous Malformations ◽  
Hemorrhagic Complications ◽  
Rapid Ventricular Pacing

BackgroundThere are no reports that describe complete flow control using concurrent transient rapid ventricular pacing or intravenous (IV) adenosine and afferent arterial balloon flow arrest to aid transvenous embolization of cerebral arteriovenous malformations (AVM). We describe our experience with the use of this technique in patients undergoing transvenous AVM embolization.MethodsConsecutive patients in whom transvenous embolization was attempted at our institute between January 2017 and July 2019 were included. Anatomical AVM features, number of embolization stages, technique of concurrent transient rapid ventricular pacing and afferent arterial balloon flow arrest, complications, and clinical and radiological outcomes were recorded and tabulated.ResultsTransvenous AVM embolization was attempted in 12 patients but abandoned in two patients for technical reasons. Complete embolization was achieved in 10 patients, five of whom had infratentorial AVMs. All 10 had a single primary draining vein. Rapid ventricular pacing was used in nine cases; IV adenosine injection was used in one case to achieve cardiac standstill. Complete AVM nidus obliteration was achieved with excellent neurologic outcome in nine cases, with transvenous embolization alone in two cases, and with staged transarterial followed by transvenous embolization in the others. Two patients developed hemorrhagic complications intraprocedurally. One patient was managed conservatively and the other operatively with AVM excision and hematoma evacuation; both made an excellent recovery without any neurologic deficits at 3 months.ConclusionComplete flow control using concurrent transient rapid ventricular pacing with afferent arterial balloon flow arrest technique is safe and feasible for transvenous embolization of select AVMs.

scholarly journals Hemorrhagic Complications after Endovascular Treatment of Cerebral Arteriovenous Malformations

2014 ◽  
Vol 35 (5) ◽  
pp. 978-983 ◽  
Author(s):  
H. Baharvahdat ◽  
R. Blanc ◽  
R. Termechi ◽  
S. Pistocchi ◽  
B. Bartolini ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Hemorrhagic Complications

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

2014 ◽  
Vol 37 (3) ◽  
pp. E17 ◽  
Author(s):  
Ching-Jen Chen ◽  
Srinivas Chivukula ◽  
Dale Ding ◽  
Robert M. Starke ◽  
Cheng-Chia Lee ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Case Series ◽  
Outcome Data ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Cerebral Arteriovenous Malformations ◽  
Control Seizure ◽  
Free Status

Object Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. Methods A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome. Results Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007). Conclusions Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.

scholarly journals Transvenous embolization of thalamic arteriovenous malformation under transient cardiac standstill

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V10
Author(s):  
Leonardo Rangel-Castilla ◽  
Hussain Shallwani ◽  
Adnan H. Siddiqui
Keyword(s):  
Magnetic Resonance Imaging ◽  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Ventricular Pacing ◽  
Resonance Imaging ◽  
Rapid Ventricular Pacing ◽  
One Year ◽  
Cerebrovascular Surgery

Transvenous embolization (TE) has been increasingly applied for arteriovenous malformation (AVM) treatment. Transient cardiac standstill (TCS) has been described in cerebrovascular surgery but is uncommon for endovascular embolization. The authors present a patient with a ruptured thalamic AVM in whom both techniques were applied simultaneously. Surgery was considered, but the patient refused. Transarterial embolization was performed with an incomplete result. The deep-seated draining vein provided sole access to the AVM. A microcatheter was advanced into the draining vein. Under TCS, achieved with rapid ventricular pacing, complete AVM embolization was obtained. One-year magnetic resonance imaging and cerebral angiography demonstrated no residual AVM.The video can be found here: https://youtu.be/CAzb9md_xBU.

Factors associated with seizures at initial presentation in pediatric patients with cerebral arteriovenous malformations

2021 ◽  
pp. 1-6
Author(s):  
Joseph H. Garcia ◽  
Ethan A. Winkler ◽  
Ramin A. Morshed ◽  
Alex Lu ◽  
Simon G. Ammanuel ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Case Series ◽  
Morphological Characteristics ◽  
Subcortical White Matter ◽  
Therapeutic Interventions ◽  
Independent Effect ◽  
Cerebral Arteriovenous Malformations ◽  
Logistic Regression Models

OBJECTIVE Children with cerebral arteriovenous malformations (AVMs) can present with seizures, potentially increasing morbidity and impacting clinical management. However, the factors that lead to seizures as a presenting sign are not well defined. While AVM-related seizures have been described in case series, most studies have focused on adults and have included patients who developed seizures after an AVM rupture. To address this, the authors sought to analyze demographic and morphological characteristics of AVMs in a large cohort of children. METHODS The demographic, clinical, and AVM morphological characteristics of 189 pediatric patients from a single-center database were studied. Univariate and multivariate logistic regression models were used to test the effect of these characteristics on seizures as an initial presenting symptom in patients with unruptured brain AVMs. RESULTS Overall, 28 of 189 patients initially presented with seizures (14.8%). By univariate comparison, frontal lobe location (p = 0.02), larger AVM size (p = 0.003), older patient age (p = 0.04), and the Supplemented Spetzler-Martin (Supp-SM) grade (0.0006) were associated with seizure presentation. Multivariate analysis confirmed an independent effect of frontal lobe AVM location and higher Supp-SM grade. All patients presenting with seizures had AVMs in the cortex or subcortical white matter. CONCLUSIONS While children and adults share some risk factors for seizure presentation, their risk factor profiles do not entirely overlap. Pediatric patients with cortical AVMs in the frontal lobe were more likely to present with seizures. Additionally, the Supp-SM grade was highly associated with seizure presentation. Future clinical research should focus on the effect of therapeutic interventions targeting AVMs on seizure control in these patients.

scholarly journals Microsurgical treatment of a posterior fossa arteriovenous malformation initially mistaken for a dural arteriovenous fistula: avoidance of near disaster

2021 ◽  
Vol 4 (1) ◽  
pp. V7
Author(s):  
Brian M. Howard ◽  
Daniel L. Barrow
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Fatal Hemorrhage ◽  
Hemorrhagic Complications ◽  
Dural Arteriovenous Fistulas

Many brain arteriovenous malformations (AVMs) derive dural blood supply, while 10%–15% of dural arteriovenous fistulas (dAVFs) have pial arterial input. To differentiate between the two is critical, as treatment of these entities is diametrically opposed. To treat dAVFs, the draining vein(s) is disconnected from feeding arteries, which portends hemorrhagic complications for AVMs. The authors present an operative video of a subtle cerebellar AVM initially treated as a dAVF by attempted embolization through dural vessels. The lesion was subsequently microsurgically extirpated. The authors show a comparison case of an AVM mistaken for a dAVF and transvenous embolization that resulted in a fatal hemorrhage.The video can be found here: https://youtu.be/eDeiMrGoE0Q

Rapid ventricular pacing for flow control during transarterial Onyx embolization of tentorial dural arteriovenous fistulas

2021 ◽  
Vol 14 (8) ◽  
pp. e242833
Author(s):  
Eisaku Tsuji ◽  
Hideo Okada ◽  
Tomoaki Terada
Keyword(s):  
Flow Control ◽  
Treatment Option ◽  
Transarterial Embolization ◽  
Embolic Agent ◽  
Ventricular Pacing ◽  
Arteriovenous Fistulas ◽  
Novel Treatment ◽  
Dural Arteriovenous Fistulas ◽  
Rapid Ventricular Pacing

We report transarterial Onyx embolization with flow control using rapid ventricular pacing (RVP) in a middle-aged male patient with tentorial dural arteriovenous fistulas (TDAVFs). The patient completed angiographic obliteration in one session without any complications, and the 6-month postangiographic obliteration follow-up showed no evidence of residual or recurrent dural arteriovenous fistulas. RVP may be a novel treatment option of flow control to facilitate the embolic agent penetrating into the venous side and to achieve complete cure in transarterial embolization of TDAVFs.

Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations

2017 ◽  
Vol 126 (3) ◽  
pp. 845-851 ◽  
Author(s):  
Benjamin J. Ditty ◽  
Nidal B. Omar ◽  
Paul M. Foreman ◽  
Joseph H. Miller ◽  
Kimberly P. Kicielinski ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Case Series ◽  
Seizure Outcome ◽  
Cerebral Arteriovenous Malformations ◽  
Surgery Outcome ◽  
Number Of Patients ◽  
Cerebral Avms

OBJECTIVE Patients with cerebral arteriovenous malformations (AVMs) commonly present with seizure. Seizure outcomes in patients treated with stereotactic radiosurgery (SRS) are poorly defined. A case series of patients with cerebral AVMs treated with SRS is presented to evaluate long-term seizure outcome. METHODS A retrospective review of the medical record was performed, identifying 204 consecutive patients with AVMs treated with SRS between January 1991 and June 2012. Clinical and radiographic data were evaluated. Seizure outcome was measured using the Engel Epilepsy Surgery Outcome Scale. Mean duration of follow-up was 37.1 months (SD 38.3 months) with a minimum follow-up period of 1 month. RESULTS Of the 204 patients with cerebral AVMs treated with SRS, 78 patients (38.2%) presented with seizures and 49 of those patients were treated with antiepileptic drugs (AEDs). Following SRS, 63 (80.8%) of the 78 patients who had had seizures prior to SRS were seizure-free at a mean follow-up time of 37.2 months (SD 41.3 months). Of the 49 patients who had been treated with AEDs, 17 were still taking AEDs at last follow-up. Of the 126 patients who did not present with seizures prior to treatment with SRS, only 5 patients (4.0%) had seizures in the post-SRS period. There was no significant correlation between post-SRS seizure status and patient demographic features, comorbidities, AVM characteristics, history of operative intervention, pre- or posttreatment hemorrhage, or radiographic degree of AVM resolution. CONCLUSIONS Stereotactic radiosurgery for treatment of cerebral AVMs is effective at providing long-term control of seizures. A substantial number of patients who were treated with SRS were not only seizure free at their last follow-up, but had been successfully weaned from antiepileptic medications.

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