Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents

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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Advantages of using a detachable-tip microcatheter and liquid embolic agents in the preoperative embolization of a recurrent cerebellar hemangioblastoma: A case report

Surgical Neurology International ◽

10.4103/sni.sni_123_17 ◽

2017 ◽

Vol 8 (1) ◽

pp. 239 ◽

Cited By ~ 1

Author(s):

JuanN Useche ◽

Nicolas Yanez ◽

LuisaK Cifuentes ◽

Marcela Mejia

Keyword(s):

Case Report ◽

Preoperative Embolization ◽

Cerebellar Hemangioblastoma ◽

Embolic Agents ◽

Liquid Embolic

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Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model

Interventional Neuroradiology ◽

10.1177/1591019918782692 ◽

2018 ◽

Vol 24 (6) ◽

pp. 693-701 ◽

Cited By ~ 11

Author(s):

Dominik F Vollherbst ◽

Ruth Otto ◽

Thuy Do ◽

Hans U Kauczor ◽

Martin Bendszus ◽

...

Keyword(s):

Cone Beam Ct ◽

Cone Beam ◽

Embolic Agent ◽

In Vivo Model ◽

Ethylene Vinyl Alcohol ◽

Embolic Agents ◽

Liquid Embolic ◽

Conventional Ct ◽

Ct And Mri

Background and purpose A frequently reported drawback of ethylene vinyl alcohol copolymer-based liquid embolic agents is the production of artifacts in diagnostic imaging. New embolic agents, such as Precipitating hydrophobic injectable liquid (PHIL; MicroVention, Tustin, CA, USA), are supposed to induce significantly fewer artifacts. The purpose of this study is to assess the degree of artifacts induced by the liquid embolic agents Onyx (Medtronic Neurovascular, Irvine, CA, USA) and PHIL in conventional computed tomography (CT), cone-beam CT and magnetic resonance imaging (MRI) in an experimental in vivo model. Materials and methods In 10 pigs the rete mirabile was embolized with Onyx ( n = 5) or PHIL ( n = 5). After embolization, conventional CT, cone-beam CT and MRI were performed. The degree of artifacts was graded qualitatively (five-point scale; for CT and MRI) and quantitatively (HUs of well-defined regions of interest (ROIs); for CT only). Results Artifacts were significantly more severe for Onyx both in the qualitative (e.g. conventional CT: 2 versus 5 (medians); p = 0.008) and in the quantitative image analysis (e.g. cone-beam CT: standard deviation of a ROI near to the embolic agent cast, 94 HU versus 38 HU (medians); p = 0.008). Neither Onyx nor PHIL produced any apparent artifacts in MRI. Conclusion PHIL produces fewer artifacts than Onyx in conventional CT and cone-beam CT in an experimental in vivo model.

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Republished: Multiplug flow control technique as a novel transarterial curative approach for the endovascular treatment of cerebrovascular malformations

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017418.rep ◽

2021 ◽

pp. neurintsurg-2021-017418.rep

Author(s):

H Saruhan Cekirge ◽

Isil Saatci

Keyword(s):

Flow Control ◽

Dural Arteriovenous Fistula ◽

Vascular Malformations ◽

The Other ◽

Control Technique ◽

Injection Time ◽

Complete Occlusion ◽

Transarterial Embolisation ◽

Embolic Agents ◽

Liquid Embolic

Herein, we describe the use of a novel multiplug flow control technique for the curative transarterial embolisation of cerebrovascular malformations using liquid embolic agents (LEAs). The idea behind the use of this technique is to substantially control or arrest flow during LEA injection, with multiple plugs simultaneously formed from microcatheters that are placed within all or multiple feeders, so that the penetration of LEAs is facilitated, with flow control decreasing the washout of a malformation. This technique enables the complete occlusion of a vascular malformation in a shorter injection time than that in other methods because penetration is achieved faster. Details of this technique have been described in the treatment of two cases: one case of unruptured temporal arteriovenous malformation and in the other with a falcotentorial dural arteriovenous fistula, in which the vascular malformations were successfully occluded with transarterial embolisation.

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Temporal Pial Arteriovenous Malformation Presenting with Headaches: Embolization Utilizing Detachable Tip Microcatheter and EVOH-Based Liquid Embolic Agent, Near Total Occlusion Complicated with Early Venous Compromise and Massive Hemorrhage; Emergency Surgery, Hematoma Evacuation, and AVM Removal with Excellent Clinical Outcome

The Arteriovenous Malformations and Fistulas Casebook ◽

10.1007/978-3-030-51200-2_18-1 ◽

2021 ◽

pp. 1-12

Author(s):

José E. Cohen ◽

Samuel Moscovici ◽

Issael J. Ramirez ◽

Sergey Spektor

Keyword(s):

Clinical Outcome ◽

Arteriovenous Malformation ◽

Emergency Surgery ◽

Massive Hemorrhage ◽

Embolic Agent ◽

Total Occlusion ◽

Hematoma Evacuation ◽

Liquid Embolic ◽

Liquid Embolic Agent ◽

Excellent Clinical Outcome

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Successful endovascular treatment of extra-intracranial arteriovenous malformation using a combination of liquid non-adhesive embolic agents

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2020.101008 ◽

2021 ◽

Vol 23 ◽

pp. 101008

Author(s):

S.M. Karasev ◽

A.A. Sufianov ◽

R.R. Khafizov ◽

I.I. Karaseva ◽

Z.Kh. Shugushev ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Intracranial Arteriovenous Malformation ◽

Embolic Agents

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Brain Arteriovenous Malformations: Treatment with Liquid Embolic Agents

Surgical Endovascular Neuroradiology ◽

10.1055/b-0034-99102 ◽

2015 ◽

Keyword(s):

Arteriovenous Malformations ◽

Brain Arteriovenous Malformations ◽

Embolic Agents ◽

Liquid Embolic

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The evolution of pre-operative spine tumour embolization

British Journal of Radiology ◽

10.1259/bjr.20180899 ◽

2019 ◽

Vol 92 (1100) ◽

pp. 20180899 ◽

Cited By ~ 1

Author(s):

Nima Omid-Fard ◽

Charles G Fisher ◽

Manraj KS Heran

Keyword(s):

Case Series ◽

Vascular Anatomy ◽

Arteriovenous Shunting ◽

Technical Parameters ◽

Capillary Networks ◽

Embolic Agents ◽

Liquid Embolic ◽

Fine Capillary ◽

Spine Tumour ◽

Tumour Characteristics

Pre-operative spine tumour embolization is a useful adjunct to minimize operative complications and blood loss during complex resections. While the efficacy of this procedure has been well studied, relatively little is documented regarding how to optimize technical parameters for tumour characteristics. This pictorial case series seeks to review our centre’s experience over the last decade in using a range of embolization techniques. As experience with this procedure has matured, we propose an approach based on the patient’s vascular anatomy and tumour angioarchitecture. This includes the use of coils as protective barriers rather than primary embolics; particle embolization to permeate fine capillary networks; consideration for liquid embolic agents in the presence of large caliber tumour vessels with associated arteriovenous shunting; and percutaneous intralesional embolization when endovascular access is insufficient to achieve the desired outcome. In many cases, a combination of these methods is needed, and close communication with the surgeon ensures the best outcome. Despite these advances, continued work is needed to determine how to optimize complete devascularization, and thus surgical benefit, while safely sparing critical neuroanatomical structures.

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