Intermittent balloon occlusion to favor nidal penetration during embolization of arteriovenous malformations: a technique modification

Endovascular embolization of brain arteriovenous malformations (AVMs) has improved with liquid occlusive agents, but flow-related and anatomic restrictions limit endovascular capabilities. AVM compartments supplied by leptomeningeal networks and feeding arteries too small and/or tortuous for safe ca...

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Bibliographic Details
Published in:BMJ Case Reports 2013, Vol.2013
Main Authors: Bank, William O, Stemer, Andrew B, Armonda, Rocco A, Bell, Randy S
Format: Report
Language:English
Subjects:
Arteriovenous Malformation
Balloon
Brain
Intervention
Liquid Embolic Material
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Summary:Endovascular embolization of brain arteriovenous malformations (AVMs) has improved with liquid occlusive agents, but flow-related and anatomic restrictions limit endovascular capabilities. AVM compartments supplied by leptomeningeal networks and feeding arteries too small and/or tortuous for safe catheterization are rarely penetrated by liquid occlusive agents. A case with both impediments prompted a novel solution. A balloon was inflated across the supply to a lenticulostriate feeder, thereby favoring penetration of the liquid occlusive agent, injected from a different feeding territory, back into the AVM compartment supplied by the temporarily occluded feeder. This technique may reduce the number of embolization stages in large high-flow AVMs and increase the likelihood of achieving complete occlusion. This technique is highly complex and requires meticulous monitoring of multiple events.
ISSN:1757-790X
DOI:10.1136/bcr-2012-010637