Arteriovenous Malformation in the Brain: A Theoretical Study Explaining the Behavior of Liquid Embolic Agents during Endovascular Treatment

We describe a case of brain cortical reorganization after embolization of a large right temporal arteriovenous malformation. A comprehensive imaging protocol, including functional magnetic resonance imaging (fMRI), cortical thickness analysis and 320-row computed tomography (CT) perfusion was used to provide information on brain plasticity and potential steal phenomenon. A 25-year-old man known for a right temporal grade V Spetzler-Martin classification arteriovenous malformation (AVM) presented with left progressive hemiparesis. He underwent functional 3T magnetic resonance imaging (fMRI), cortical thickness analysis, and CT perfusion (CT 320 row, Aquilion ONE, Toshiba, Tokyo, Japan) before and after endovascular treatment. The results were compared to look for modifications in brain perfusion and organization. An improvement in the left hemiparesis and a reorganization of motor function were observed after endovascular treatment. Modifications in the angioarchitecture and perfusion of an extensive AVM may be accompanied by a functional and structural reorganization of the brain. The location in the so-called eloquent regions may not be sufficient to explain the wide spectrum of symptoms that these patients can present. A more comprehensive approach considering a global involvement of the brain in patients with large AVMs is suggested to achieve the best treatment strategy and to stage treatment in incurable AVMs.

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

Neurosurgery ◽

10.1227/01.neu.0000170538.74899.7f ◽

2005 ◽

Vol 57 (3) ◽

pp. 449-459 ◽

Cited By ~ 43

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.

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Experience of intracranial arteriovenous malformations endovascular treatment with advanced techniques and non-adhesive liquid embolic agents using

Endovascular Neuroradiology ◽

10.26683/2304-9359-2020-3(33)-29-38 ◽

2020 ◽

Vol 33 (3) ◽

pp. 29-38

Author(s):

Yu.V. Cherednichenko ◽

L.A. Dzyak ◽

E.S. Tsurkalenko

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Low Frequency ◽

Endovascular Embolization ◽

Average Decrease ◽

Embolic Agents ◽

Increased Risk ◽

Liquid Embolic ◽

Risk Of Rupture ◽

Clinically Significant

Objective ‒ to evaluate the possibility of endovascular embolization using non-adhesion of liquid embolic agents as monotherapy for the treatment of cerebral arteriovenous malformations (AVM), its reliability and safety.Materials and methods. examination and gradual endovascular treatment of 64 patients (120 sessions) using non-adhesive liquid embolic agents. Patients were divided into two groups: with ruptured AVM (n = 43) and with unruptured (n = 21). In all cases of unruptured AVM, signs indicating an increased risk of rupture of the AVM were verified.Results. the average decrease in volume after embolization was 79.5 % (up to 50 % ‒ in 7 cases, 50‒75 % ‒ in 14, 75‒99 % ‒ in 29). Complete exclusion of AVM was achieved in 14 (22 %) patients. On average, 2–3 feeders were embolized on the AVM to achieve such results. It was found that the number of feeders was directly proportional to the number of sessions required. Malformations of small size (up to 3 cm) often managed to close in one session. Clinically significant deficiency (2 on the modified Rankin scale) after embolization was found in 2 (3 %) patients. The deficit regressed within 7 days. The angiographic frequency of complete obliteration of AVM at the end of all embolization procedures was 22 % (14 AVM).Conclusions. knowledge of the angioarchitectural characteristics of AVM, which are suitable for the treatment with liquid embolic agents, and their careful selection allow to achieve a high frequency of occlusion with a low frequency of complications. The use of superselective intranidal or perinidal positions of the catheter, slow controlled injections that protect the draining veins, the gradual embolization make the therapy safer.

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Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis

Clinical Neuroradiology ◽

10.1007/s00062-021-01107-0 ◽

2021 ◽

Author(s):

Andrea M. Alexandre ◽

Carmelo Lucio Sturiale ◽

Andrea Bartolo ◽

Andrea Romi ◽

Alba Scerrati ◽

...

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Meta Analysis ◽

Complication Rates ◽

Arteriovenous Fistulas ◽

First Line Therapy ◽

Ovid Medline ◽

Embolic Agents ◽

Liquid Embolic ◽

Dural Arteriovenous Fistulas

Abstract Purpose Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.

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Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents

American Journal of Neuroradiology ◽

10.3174/ajnr.a0793 ◽

2008 ◽

Vol 29 (2) ◽

pp. 242-246 ◽

Cited By ~ 74

Author(s):

M.V. Jayaraman ◽

M.L. Marcellus ◽

S. Hamilton ◽

H.M. Do ◽

D. Campbell ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Neurologic Complications ◽

Embolic Agents ◽

Liquid Embolic

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

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.16-18 ◽

2019 ◽

Vol 1 (1) ◽

pp. 16-18 ◽

Cited By ~ 1

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.

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

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.11.16-18 ◽

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.

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Emergency tips recanalisation and gastroesophageal varices embolisation with an ethylene vinyl alcohol copolymer agent (Squid) and detachable coils

European Radiology Experimental ◽

10.1186/s41747-020-00196-9 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Massimo Venturini ◽

Luigi Augello ◽

Carolina Lanza ◽

Marco Curti ◽

Andrea Coppola ◽

...

Keyword(s):

Therapeutic Option ◽

Technical Note ◽

Embolic Agent ◽

Refractory Ascites ◽

Gastroesophageal Varices ◽

Ethylene Vinyl Alcohol ◽

Embolic Agents ◽

Liquid Embolic ◽

Tube Removal ◽

Detachable Coils

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) is currently indicated as first therapeutic option in the main complications of portal hypertension, including bleeding gastroesophageal varices and refractory ascites. In case of bleeding gastroesophageal varices, an adjuvant embolisation within TIPS can be useful to prevent rebleeding. In the present technical note, the management in emergency of a patient with haemorrhagic shock due to bleeding gastroesophageal varices and occluded TIPS is reported. TIPS recanalisation with an adjunctive stent and high-pressure balloon angioplasty and gastroesophageal varices embolisation using detachable coils and a non-adhesive liquid embolic agent were performed during the same emergent procedure. After the procedure, clinical stabilisation of the patient was achieved, with blood transfusions suspension and Blakemore tube removal. At 6 months, regular TIPS patency at colour Doppler and no rebleeding episodes were recorded. To our knowledge, whilst coils are routinely used for varices embolisation, non-adhesive liquid embolic agents have been never mentioned. Liquid embolic agents seem to provide a stable plug strengthening the embolising action of the coils. Further studies involving a cohort of patients with long-term follow-up will be necessary to confirm whether this association can be more effective than coils alone in gastroesophageal varices embolisation.

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