Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning

Song, Jinzhao; Eskridge, Joseph M.; Chung, Eun Chul; Blake, Lindsey; Elliott, Joseph P.; Finch, Lisa; Niakan, C; Maravilla, K R; Winn, H. Richard

doi:10.3171/jns.2000.92.6.0955

Cited by 31 publications

(16 citation statements)

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“…9,30 The incidence of endovascular embolization-induced delayed hemorrhage is not frequent and ranges from 3 to 5%. 4,12,17,21 In our series, however, we found only one case of delayed hemorrhage, in which there were no clinical signs. In our series, there was no angiographic evidence of vasculitis, and histological analysis showed no or only a nonspecific inflammatory response.…”

Section: Discussionmentioning

confidence: 39%

“…25 As expected, the most common complication is cerebral infarction in the territory of the embolized vessels. Song, et al, 21 reported 26 cases of presumed acute ischemia in a series in which 230 embolization procedures were performed. In addition to occlusion of the vessel by the embolic agent, ischemia may result from an autologous clot produced by manipulation of the catheter or guidewire.…”

Section: Discussionmentioning

confidence: 99%

“…3,20,21,28 We consider silk suture to be an effective and safe embolic agent for the preoperative embolization of cerebral and dural AVMs. In this study the estimated silk suture-related complication rate was 0% for permanent deficit and 0.09% for temporary deficit; the mortality rate was 0%.…”

Section: Discussionmentioning

confidence: 99%

“…Because the first step of the surgical management of AVMs is to define the feeding sources of the lesion, silk suture embolization is useful. 10,12,20,21,25,30 Agents currently used for embolization of cerebral AVMs include NBCA, PVA foam, microcoils, and silk sutures. Intranidal injection of NBCA can be curative in some patients harboring low-grade AVMs, but recanalization may occur.…”

Section: Discussionmentioning

confidence: 99%

“…8,14,16,18 It has been claimed that silk sutures induce an inflammatory reaction and treatment-related complications. 4,9,20,21,30 Although immediate or delayed hemorrhage associated with embolization can be a devestating complication, the direct relation between inflammatory response and subsequent hemorrhage remains unclear. 7,11,17 Deveikis, et al, 4 have described hemorrhage-related complications in a few cases in which silk suture was one of the preoperative embolic agents.…”

mentioning

confidence: 99%

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Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Ar¹,

Muster²,

Reverdin³

et al. 2001

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Object The aim of this study was to evaluate the use of silk sutures as a medical implant when applied for the embolization of cerebral and dural arteriovenous malformations (AVMs). The facility of surgery and the clinical significance of complications related to preoperative silk suture embolization were evaluated immediately after surgery and at long-term follow up. Methods Thirty-four patients harboring 29 cerebral and five dural AVMs underwent embolization in which silk alone or in association with other agents was used. Medical and radiological records obtained in these 34 patients were reviewed retrospectively. The cerebral AVMs were classified according to the Spetzler–Martin grading system and the dural AVMs to the Djindjian grading system. The facility of the resection and the adverse outcomes, including new neurological deficits, hemorrhage, and fever, as well as histopathological evidence of vessel inflammatory changes, were determined in each case. In all 23 surgical cases, the AVM could be easily manipulated and excised. New temporary neurological deficits occurred in three patients. A high Spetzler–Martin grade was not associated with a higher incidence of new neurological deficits. One delayed-onset hemorrhage was detected after embolization. Fever was present in 24% of the patients. No sign of significant vasculitis or perivascular inflammation was found on radiological or histopathological examination. Conclusions Silk sutures are safe embolic agents especially for proximal occlusion of AVM feeding vessels. New permanent neurological deficits were not encountered in this series. Fever was considered to be a minor, temporary side effect of silk suture embolization.

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Section: Discussionmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 99%