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

Bank, William O.; Stemer, Andrew; Armonda, Rocco A.; Bell, Randy S.

doi:10.1136/neurintsurg-2012-010637.rep

Cited by 5 publications

(1 citation statement)

References 8 publications

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“…16,17 Furthermore, the intermittent balloon occlusion technique enhances the penetration of Onyx by reducing back pressure. 18 Although these techniques are useful, they are not applicable to some cases in which the goal of endovascular treatment is the partial or targeted embolization of deep feeders. 19,20 Among the distal access catheters available in our country in the study period, we chose Fubuki 4.2Fr (Asahi Intecc Co., Ltd.).…”

Section: Potential Benefits Of Our Techniquementioning

confidence: 99%

S-shaped distal access catheter supported microcatheter navigation into the lenticulostriate artery feeders of brain arteriovenous malformations

et al. 2020

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Background Although the embolization of lenticulostriate artery feeders is often warranted in the treatment of brain arteriovenous malformations, it is technically challenging due to steep and repeated angulations. Here, we describe our novel technique of navigating a flow-guided microcatheter into lenticulostriate artery feeders using the strong support provided by an S-shaped distal access catheter. Methods We reviewed our retrospective cohort of brain arteriovenous malformations, in which lenticulostriate artery feeders were attempted to embolize. Result During the study period, endovascular embolization was performed in 25 arteriovenous malformations cases. Of these, eight lenticulostriate artery feeders were present in six cases (24%). In two cases, lenticulostriate artery feeder catheterization was avoided from the beginning due to the small diameters of the feeders. After all, microcatheter navigation for lenticulostriate artery feeders were attempted in four cases with six lenticulostriate artery feeders. In all the six feeders, the S-shaped distal access catheter was successful in supporting the microcatheter to advance distally to the lenticulostriate artery feeders, even if other approaches were unsuccessful. Of the six catheterized lenticulostriate artery feeders, four were embolized. Symptomatic infarction in the lenticulostriate artery territory and mild vasospasm occurred in two cases each, but they did not result in permanent neurological deficits. Conclusion Although some potential complications need to be considered, the S-shaped distal access catheter technique appears to be an effective alternative approach to gaining access to difficult feeders of arteriovenous malformations.

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Section: Potential Benefits Of Our Techniquementioning

confidence: 99%

S-shaped distal access catheter supported microcatheter navigation into the lenticulostriate artery feeders of brain arteriovenous malformations

et al. 2020

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Embolization of brain arteriovenous malformations with the diluted Onyx technique: initial experience

Wang²,

Guan

et al. 2019

Neuroradiology

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

Cekirge

Saatçi

2021

BMJ Case Rep

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

Cited by 5 publications

References 8 publications

S-shaped distal access catheter supported microcatheter navigation into the lenticulostriate artery feeders of brain arteriovenous malformations

S-shaped distal access catheter supported microcatheter navigation into the lenticulostriate artery feeders of brain arteriovenous malformations

Embolization of brain arteriovenous malformations with the diluted Onyx technique: initial experience

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

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