Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation: A Technical Note

2021 ◽  
pp. 1-6
Author(s):  
Daniel Chang ◽  
Robin Babadjouni ◽  
Peyton Nisson ◽  
Julie Lynn Chan ◽  
Miguel Quintero-Consuegra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Clinical Signs ◽  
Technical Note ◽  
Vein Of Galen ◽  
Pressure Monitoring ◽  
Flow Reduction ◽  
Embolic Materials ◽  
Transvenous Approach

<b><i>Introduction:</i></b> Vein of Galen malformations (VGMs) are complex congenital arteriovenous malformations that generally require serial endovascular treatment sessions to slowly correct the high-flow fistulous connections that cause increased venous pressures and ultimately lead to the classic presentations of heart failure, hydrocephalus, and intracranial hemorrhages. Despite the advances in endovascular technology and embolic materials, the resolution of embolization is often limited to the subjective view of diminished flow on angiograms. <b><i>Case Report:</i></b> An 8-month-old patient with a VGM developed clinical signs of heart failure and growing head circumference with ventriculomegaly. The patient was treated endovascularly with a transvenous approach for coil embolization while undergoing continuous monitoring of the post-malformation venous pressures. The arterial and venous systolic blood pressures (SBP) were collected at serial time points and used to measure estimated 95% confidence interval bounds for arteriovenous SBP gradients and determine when sufficient coil embolization and flow reduction was thought to be achieved. <b><i>Conclusion:</i></b> The transvenous pressure monitoring demonstrated progressively increasing pressure gradients between the arterial and venous systems that correlated with the degree of flow reduction on angiographic runs. The patient underwent successful coil embolization of the VGM and had improvement of heart failure and ventricular size in follow-up at 8-month post-op. This provides a novel technique to introduce an objective measurement that can guide the embolization of a VGM.

scholarly journals Transnasal flow reduction in endovascular treatment for anterior cranial fossa dural arteriovenous fistula

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Shuhei Kawabata ◽  
Hajime Nakamura ◽  
Takeo Nishida ◽  
Masatoshi Takagaki ◽  
Nobuyuki Izutsu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Anterior Cranial Fossa ◽  
Maxillary Artery ◽  
Flow Reduction ◽  
Cranial Fossa ◽  
Embolic Materials

ABSTRACT Transarterial embolization (TAE) is a useful option for anterior cranial fossa–dural arteriovenous fistula (ACF–dAVF) as endovascular devices have progressed. Liquid agents are usually injected via a microcatheter positioned just proximal to the shunt pouch beyond the ophthalmic artery; however, high blood flow from the internal maxillary artery (IMA) often impedes penetration of embolic materials into the shunt pouch. Therefore, reducing blood flow from the IMA before embolization can increase the success rate. In the present case, to reduce blood flow from branches of the IMA, we inserted surgical gauze infiltrated with xylocaine and epinephrine into bilateral nasal cavities. Using this method, we achieved curative TAE with minimal damage to the nasal mucosa. Transnasal flow reduction is an easy, effective and minimally invasive method. This method should be considered in the endovascular treatment of ACF–dAVF, especially in patients with high blood flow from theIMA.

scholarly journals A Technical Note

2013 ◽  
Vol 19 (1) ◽  
pp. 27-34 ◽  
Author(s):  
V.M. Pereira ◽  
A. Marcos-Gonzalez ◽  
I. Radovanovic ◽  
P. Bijlenga ◽  
A.P. Narata ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Young Patient ◽  
Arteriovenous Malformations ◽  
Technical Note ◽  
Cerebral Arteriovenous Malformations ◽  
Arterial Access ◽  
Therapeutic Method ◽  
Endovascular Approach ◽  
Ruptured Avm ◽  
Transvenous Approach

Ruptured cerebral arteriovenous malformations (AVMs) usually require treatment to avoid re-bleeding. Depending on the angioarchitecture and center strategy, the treatment can be surgical, endovascular, radiosurgical or combined methods. The classic endovascular approach is transarterial, but sometimes it is not always applicable. The transvenous approach has been described as an alternative for the endovascular treatment of small AVMs when arterial access or another therapeutic method is not possible. This approach can be considered when the nidus is small and if there is a single draining vein. We present a technical note on a transvenous approach for the treatment of a ruptured AVM in a young patient.

Abstract TP407: Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Chang ◽  
Miguel D Quintero-Consuegra ◽  
Juan F Toscano ◽  
Robin Babadjouni ◽  
Kelly Danielpour ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Pressure ◽  
Common Femoral Artery ◽  
High Morbidity ◽  
Vein Of Galen ◽  
Continuous Assessment ◽  
Pressure Monitoring ◽  
Vein Of Galen Malformation ◽  
Diagnostic Angiography ◽  
The Difference

Background: Vein of Galen Malformation (VGM) is a complex vascular disorder with high morbidity and mortality. Mainstay management involves staged endovascular embolizations. Determining when to stop an embolization during any single intervention is challenging. If embolization is excessive, it precipitates thrombosis on the VGM, increase in cardiac post-load, and worsening on heart failure, as well as hemorrhages. Conversely, insufficient embolization may be futile. We report the use of transvenous pressure monitoring as an adjuvant for guiding the extent of embolization. Method: Arterial and venous accesses were obtained through the common femoral artery and vein, respectively. After diagnostic angiography, the best working projection was selected in early and late venous phases. A microcatheter was placed at the VG, and an intermediate 5 Fr. catheter was located at the persistent falcine sinus. The microcatheter was used for coil embolization, while the intermediate catheter provided support and was connected for continuous venous pressure monitoring. Continuous arterial pressure monitoring was obtained via an A-line and transduction of a glide catheter located in the carotid artery. Arterial and venous SBP were recorded. Result: Serial angiograms during treatment showed reduction of flow within the VGM. Concomitantly, there was an increase in the A-V-gradient over time (Figure 1). The difference between the A-V SBP went from 36 mmHg at the start of the case to 51 mmHg after the final coil. The average pressure gradient went from 38.3 mmHg in the first quarter to 43.5 mmHg in the last. Conclusion: The continuous assessment of transvenous pressure monitoring during embolization of VGM provides measurable changes that correlate with degree of flow. This quantifiable metric may be used as an adjunct to guide adequate reduction of flow during endovascular treatment of VGM.

scholarly journals Delayed and incomplete treatment may result in dural fistula development in children with Vein of Galen malformation

2017 ◽  
Vol 24 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Dan Meila ◽  
Cynthia Schmidt ◽  
Katharina Melber ◽  
Dominik Grieb ◽  
Cornelius Jacobs ◽  
...  
Keyword(s):  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Treatment Timing ◽  
Arteriovenous Fistulas ◽  
Considerable Impact ◽  
Embolic Materials ◽  
Proximal Occlusion ◽  
Transvenous Approach ◽  
First Time ◽  
Incomplete Treatment

The association of dural arteriovenous fistulas (DAVF) in children with Vein of Galen malformation (VGM) has recently been reported for the first time. In a larger series of cases treated with transarterial NBCA embolization, 30% had DAVF. We wanted to analyze the development of DAVF in our cohort of children with VGM and to evaluate whether their occurrence depends on different treatment timing and embolic materials. We analyzed 43 VGM cases treated with a combined transarterial and transvenous approach between 2003 and 2016. In our early series until 2011, we used coils solely in 21 children. Since 2012, 22 children were treated with the combination of coils and Onyx. In the early series treated with coils solely, no case presented initially with or developed DAVF over time on follow-up angiograms. In our recent series we found four cases (9%) with DAVF. In two patients (5%), DAVF were found on the initial angiogram. Both patients presented at our department at age >2 years and were not treated elsewhere before. One patient (2%) presented at our department with too proximal occlusion of arterial feeders performed at another institution before. Only one patient (2%) developed DAVF in our department after the transarterial use of Onyx. Interestingly, this child did not develop DAVF as long as we used coils solely and his DAVF was localized exactly where an Onyx cast was identified. In conclusion, delayed and incomplete treatment may have a considerable impact on the occurrence of DAVF in VGM.

Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 449-459 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Yassine Kanaan ◽  
Paolo Perrini ◽  
Hayan Dayoub ◽  
Kenneth Fraser
Keyword(s):  
Endovascular Treatment ◽  
Effective Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Clinical Experiences ◽  
Endovascular Techniques ◽  
Future Directions ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Embolic Materials

ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

Endovascular treatment of mural-type vein of Galen malformations

1998 ◽  
Vol 89 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
Peter A. Balousek ◽  
Samuel F. Ciricillo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Vein Of Galen ◽  
Femoral Access ◽  
Content Type ◽  
Complete Closure ◽  
Detachable Coils ◽  
Transvenous Approach ◽  
Fine Print

Object. In this study the authors report on the results of endovascular treatment for mural-type vein of Galen malformations (VGMs) in a group of infants. Methods. Eight children (six infants and two neonates) who suffered from symptoms caused by a mural-type VGM were treated by means of endovascular therapy. Their age at the time of treatment ranged from 13 days to 19 months (mean 7.6 months). Two neonates and three infants who presented with hydrocephalus and increased head circumference, one of whom was stabilized with a shunt, underwent elective closure of the malformations 3, 4, 6, 6, and 13 months later, respectively. Two patients presented with hemorrhage; one had an intraventricular hemorrhage (IVH) on the 1st day of life and one, a 5-month-old infant, suffered a large parenchymal hemorrhage and an IVH; both patients were immediately cured by means of endovascular techniques. One child presented with a seizure and cortical venous drainage that were treated immediately. Eleven separate treatment sessions were conducted; eight via transarterial femoral access and the remaining three via a transvenous approach. Two patients were treated by using transfemoral transvenous embolization with fibered coils, and one patient required a transtorcular transvenous approach to permit complete closure of the fistula with electrolytically detachable coils. The embolic devices used included silk suture emboli (three patients), electrolytically detachable coils (three patients), and fibered platinum coils (seven patients). In seven patients, complete closure was demonstrated on postembolization arteriographic studies. The eighth patient had stagnant flow in a giant 6-cm varix treated with arterial and venous coils but has not yet undergone follow-up studies. Late follow-up arteriography was performed in four patients at times ranging from 11 to 24 months postprocedure. In one patient, thrombosis of the malformation and shrinkage of the varix were confirmed on follow-up computerized tomography scanning. The remaining three patients have not yet undergone follow-up angiographic examination. Two asymptomatic complications occurred, including separation of the distal catheter, which was removed with a snare device, and a single platinum coil that embolized to the lung, producing no symptoms in 101 months of clinical follow up. The follow-up period ranged from 3 to 105 months, with a mean of 52 months. Conclusions. Endovascular therapy is the treatment of choice for mural-type VGMs and offers a high rate of cure with low morbidity.

scholarly journals Transvenous microguidewire looping technique for breach of ipsilateral inferior petrosal sinus occlusions en route to cavernous sinus dural arteriovenous fistulas

2016 ◽  
Vol 22 (5) ◽  
pp. 590-595 ◽  
Author(s):  
Young Dae Cho ◽  
Jong Kook Rhim ◽  
Dong Hyun Yoo ◽  
Hyun-Seung Kang ◽  
Jeong Eun Kim ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Coil Embolization ◽  
Inferior Petrosal Sinus ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Embolic Materials ◽  
Transvenous Approach ◽  
Cure Rates ◽  
Guiding Catheter

Background and purpose Transarterial access to dural arteriovenous fistulas (dAVFs) has been popularized by device improvements and novel embolic materials. However, this approach is limited in the cavernous sinus (CS) because of related complications and low cure rates. Although a transvenous approach, via ipsilateral inferior petrosal sinus (IPS), may be more suitable for CS-dAVFs, microcatheter delivery is occasionally impeded by ipsilateral IPS occlusion. Described herein is a microguidewire looping method to breach such occlusions, thus enabling access to CS lesions. Methods A microcatheter is initially advanced into the IPS orifice, and a microguidewire is passed into the occluded IPS. Looping is easily achieved through the resistance met. With greater support of the guiding catheter, the microguidewire (still looped) is then advanced into the CS. When nearing the CS, the microcatheter is further reinforced, and it is navigated along the microguidewire into the CS. Results This technique was applied in 10 instances of CS-dAVF with ipsilateral IPS occlusion, enabling ipsilateral access to the CS. In eight cases (80%), microdevice advancement was successful, culminating in effective transvenous coil embolization. Clinical and radiologic outcomes in all patients were excellent, with no delayed post-procedural cranial palsies. Conclusion This microguidewire looping technique enables safe and effective entry into the CS during transvenous coil embolization of CS-dAVFs with ipsilateral IPS occlusion.

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

2019 ◽  
Vol 1 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Norafida Bahari ◽  
Nik Azuan Nik Ismail ◽  
Jegan Thanabalan ◽  
Ahmad Sobri Muda
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Value ◽  
Cone Beam ◽  
Brain Arteriovenous Malformation ◽  
Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report.

2019 ◽  
pp. 16-18
Author(s):  
Norafida Bahari ◽  
NikAzuan Nik Ismail ◽  
Jegan Thanabalan ◽  
Ahmad Sobri Muda
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Value ◽  
Cone Beam ◽  
Brain Arteriovenous Malformation ◽  
Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

Successful Surgical and Anesthetic Management of Vein of Galen Aneurysm in a Neonate in Congestive Heart Failure

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 908-910 ◽  
Author(s):  
Jane Matjasko ◽  
Walker Robinson ◽  
Daniel Eudaily
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Failure ◽  
Growth And Development ◽  
Anesthetic Management ◽  
Vascular Supply ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Vein Of Galen Aneurysm

Abstract A 12-day-old infant in intractable cardiac failure due to a vein of Galen malformation was treated successfully with serial ligation of the majority of the vessels feeding the malformation. Despite some residual vascular supply to the malformation, the congestive heart failure has disappeared and growth and development have been normal over a 3-year follow-up period.

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