Role of Superselective Angiography in the Detection and Endovascular Treatment of Ruptured Occult Arteriovenous Malformations

Abstract

<jats:p> Three cases of occult micro-arteriovenous malformations not identified by cerebral angiography or other imaging modalities were detected by superselective angiography. The first case had a small intracerebral hemorrhage in the superior colliculus, the second had a perimesencephalic subarachnoid hemorrhage, and the third presented with intracerebral hemorrhage combined with massive intraventricular hematoma. While repeated selective cerebral angiography (four-vessel study) was negative, superselective angiography clearly demonstrated each lesion with small early venous filling in accordance with the location of hematoma. Successful superselective embolization with polyvinyl alcohol particles was performed in each micro-arteriovenous malformation by flow-guided microcatheter without postoperative complications. Our experience suggests that superselective angiography is necessary to visualize micro-arteriovenous malformations in patients with cerebral hemorrhage and negative four-vessel angiography. Furthermore, the superselective endovascular approach has the advantage of offering immediate obliteration of the micro-shunt, thereby reducing or eliminating the risk of further hemorrhage. </jats:p>

Endovascular treatment of intracranial microarteriovenous malformations

“…4 In the present study 2 lesions were only demonstrated angiographically 3 and 6 months postbleeding. Superselective angiography 2,13,18 increases the diagnostic yield, allowing a definite diagnosis and permits better evaluation of the anatomical location and the angioarchitecture of the lesion. Willinsky and colleagues 18 described 5 patients with micro-AVMs who underwent superselective angiography.…”

Delayed Appearance of Radiologically Occult Cerebral Arteriovenous Malformation : A Case Report and Literature Review

“…However, there have been rare cases diagnosed only by the pathologic examinations after the surgical acquisition of the specimen, with no radiological evidences of the AVMs. 2,5,6,20,22,24,26,27,32) In the pre-MR era when lesions were evaluated with brain CT and DSA alone, such rare cases were called angiographically occult AVMs. 22) Crawford and Russell et al firstly used the term "cryptic" for small angiomatous malformation that could not be localized due to hematoma and small size.…”

Selective and Superselective Angiography of Pediatric Moyamoya Disease Angioarchitecture in the Posterior Circulation

“…Superselectivity in cerebral angiography has been implemented in our institution for 27 years and is routinely used as an additional diagnostic tool in selected cases. Its diagnostic yield and safety for children and adults has been proved for almost every aspect of cerebrovascular pathology [15][16][17][18][19][20][21][22] . Other groups have also reported on the role and safety of superselective catheterization for the endovascular approach to small calibre vessels with aneurysms, the evaluation of newly formed collaterals after revascularization procedures in children with moyamoya, even after catheterization of the vasospasm-prone middle meningeal and temporal arteries [23][24][25][26][27] .…”