Endovascular treatment of brain arteriovenous malformations involving the anterior cerebral artery

Abstract Background: There have been few studies on endovascular treatment (EVT) of the brain arteriovenous malformations (BAVMs) involving the anterior cerebral artery (ACA). Methods and materials: This study continuously enrolled 60 patients with ACA-BAVMs treated with EVT. ACA-BAVMs were divided into three types: type I BAVMs were those located below and in front of the corpus callosum genu, type II BAVMs were those located in the upper area of the corpus callosum from the genu to the anterior trunk, and type III BAVMs were those located in the upper area from the anterior trunk to the splenium of the corpus callosum. Results: The patients were aged 10 to 72 years (mean, 35.4 ±17.0 years) and included 28 females (46.7%, 28/60). BAVMs were type I (15%, 9/60), type II (25%, 15/60), and type III (60%, 36/60). Statistical analysis showed that posterior cerebral artery (PCA) tended to be involved in type II and III BAVMs. For EVT, immediate complete or nearly complete embolization was achieved in 34 (56.7%, 34/60) cases. During EVT, there were 3 cases of intraoperative bleeding (5%, 3/60), which tended to occur in type I and II ACA-BAVMs. At discharge, 80% of patients had a GOS score of 5. During the follow-up, 89.3% of patients had mRS scores of 0 and 1. Conclusion: This study showed that EVT carries a risk of intraoperative bleeding for type I and II BAVMs, for type II and III BAVMs, the PCA can often be involved in EVT. In general, EVT can result in a good prognosis for ACA-BAVMs.

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Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Frontiers in Neurology ◽

10.3389/fneur.2020.609461 ◽

2021 ◽

Vol 11 ◽

Author(s):

Kun Hou ◽

Chao Li ◽

Han Su ◽

Jinlu Yu

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Arteriovenous Malformations ◽

Posterior Cerebral Artery ◽

Postoperative Bleeding ◽

Venous Drainage ◽

Type I ◽

Type Ii ◽

Brain Arteriovenous Malformations ◽

Imaging Characteristics

Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

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Detachable-Tip Microcatheters for Liquid Embolization of Brain Arteriovenous Malformations and Fistulas: A United States Single-Center Experience

Operative Neurosurgery ◽

10.1227/neu.0000000000000839 ◽

2015 ◽

Vol 11 (3) ◽

pp. 404-411 ◽

Cited By ~ 12

Author(s):

Nabeel A Herial ◽

Asif A Khan ◽

Gregory T Sherr ◽

Mushtaq H Qureshi ◽

M Fareed K Suri ◽

...

Keyword(s):

Cerebral Artery ◽

Arteriovenous Malformations ◽

Anterior Cerebral Artery ◽

Middle Meningeal Artery ◽

Clinical Results ◽

Occipital Artery ◽

Arteriovenous Fistulas ◽

Brain Arteriovenous Malformations ◽

Single Center Experience ◽

Liquid Embolic

Abstract BACKGROUND The US Food and Drug Administration recently approved a detachable-tip microcatheter, the Apollo microcatheter (eV3, Inc, Irvine, California), to prevent catheter entrapment during embolization of brain arteriovenous malformations (AVMs) using liquid embolic systems. OBJECTIVE To report technical aspects and clinical results of cerebral embolizations with the Apollo microcatheter in 7 embolizations in 3 adult patients. METHODS A 62-year-old man presented with an AVM in the parieto-occipital region measuring 3.6 × 1.6 cm with major cortical feeders from the right middle cerebral artery (MCA) and minor contribution from the distal right anterior cerebral artery. Two pedicles originating from the MCA were embolized. A 48-year-old woman presented with a left frontal AVM measuring 3.3 × 1.8 cm with arterial feeders from the left MCA, left middle meningeal artery, and contralateral anterior cerebral artery. Three pedicles originating from the left MCA were embolized. A 76-year-old man presented with an arteriovenous fistula with multiple fistulous connections and feeders from both vertebral and occipital arteries and the left posterior cerebral artery draining into the left transverse, torcula, and left sigmoid sinus. Two major occipital artery feeders were embolized. RESULTS Seven Apollo microcatheters were used with the Onyx 18 liquid embolic system. The length of the detachable tip was 15 mm in 2 and 30 mm in 5 embolizations. The mean microcatheter in-position time within the pedicle was 20 minutes. Detachment of tip occurred in 3 instances. No limitations in accessing target arterial feeders and safe tip disengagement were noted despite prolonged injection times. CONCLUSION Our initial experience supports the feasibility, safety, and effectiveness of detachable-tip microcatheters in treating brain AVMs and arteriovenous fistulas.

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Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage

The Neuroradiology Journal ◽

10.1177/197140091102400610 ◽

2011 ◽

Vol 24 (6) ◽

pp. 886-888 ◽

Cited By ~ 5

Author(s):

P. Jiang ◽

X. Lv ◽

Z. Wu ◽

Y. Li ◽

C. Jiang ◽

...

Keyword(s):

Endovascular Treatment ◽

Posterior Fossa ◽

Arteriovenous Malformations ◽

Venous Drainage ◽

Brain Arteriovenous Malformations ◽

Male Sex

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.

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Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000176 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S74-S82 ◽

Cited By ~ 57

Author(s):

R. Webster Crowley ◽

Andrew F. Ducruet ◽

Cameron G. McDougall ◽

Felipe C. Albuquerque

Keyword(s):

Endovascular Treatment ◽

Surgical Resection ◽

Arteriovenous Malformations ◽

Treatment Options ◽

Brain Arteriovenous Malformations ◽

Short Period ◽

Cerebral Avms ◽

Brain Avms ◽

The Brain ◽

The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

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Endovascular treatment of anterior cerebral artery occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017735 ◽

2021 ◽

pp. neurintsurg-2021-017735

Author(s):

Mayank Goyal ◽

Petra Cimflova ◽

Johanna Maria Ospel ◽

René Chapot

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Ct Perfusion ◽

Correct Diagnosis ◽

Motor Deficit ◽

Anterior Communicating Artery ◽

Routine Basis ◽

Multiphase Ct ◽

High Level

There are limited data on endovascular treatment (EVT) for anterior cerebral artery (ACA) occlusions. This review focuses on aspects related to ACA EVT: ACA anatomy, clinical and imaging findings, prognosis of ACA stroke, and ACA thrombectomy techniques. The ACA anatomy, and the regions supplied by the ACA, are highly variable; frequent anatomical variants include azygos ACA, triplicated ACA and fenestrations of the anterior communicating artery. ACA occlusions can be classified based on occlusion location, their continuity with other vessel occlusions (isolated ACA occlusion vs ACA occlusion as part of a carotid T occlusion) and etiology (primary—spontaneous ACA occlusion, vs secondary—spontaneous or iatrogenic due to clot fragmentation/migration). Symptoms of ACA stroke differ in severity and nature due to large inter-individual variations in territorial ACA blood supply. Generally, ACA strokes are severely disabling, and the typical clinical hallmark is a motor deficit of the contralateral lower extremity. Advanced imaging (CT perfusion, multiphase CT angiography) increases the likelihood of the correct diagnosis of ACA stroke and should be obtained on routine basis.Available data for ACA EVT suggest its feasibility and safety while clinical outcomes are often unfavorable with conservative management. Therefore, the potential benefit of EVT seems obvious. An optimized endovascular approach for ACA thrombectomy comprises the development and use of smaller and softer devices that can be delivered through small microcatheters with an optimized vector of force. Ultimately, generating high-level evidence for ACA EVT from randomized trials remains warranted.

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