Transvenous Curative Embolization of Cerebral Arteriovenous Malformations: A Prospective Cohort Study

Abstract

This prospective contemporary series demonstrates a high rate of complete AVM obliteration and excellent functional outcomes in patients with both ruptured and unruptured AVMs treated with transvenous embolization. This approach is promising and warrants further investigation as a treatment for select AVMs.

A Case of Brainstem Arteriovenous Malformation Cured by Transvenous Embolization with Onyx

“…The following methods for transvenous embolization have been reported: (1) reduction of the mean blood pressure to 40-50 mmHg, (2) occlusion of the feeder artery with a balloon, and (3) placement of coils in the draining vein when its diameter is large. 7,8,17) As hemorrhage occurred due to venous perforation in the present patient, the basilar artery was occluded with a balloon until extravasation was no longer observed. Considering that arterial blood flow can be reduced by transarterial embolization, the systolic blood pressure was reduced to 80 mmHg or lower and Onyx was injected without occlusion with a balloon.…”

“…Cerebral infarction, cerebral edema, venous infarction, and hemorrhage have been reported as complications of transvenous embolization. 7,8) In the current patient, SPS was perforated by the microcatheter during vein selection, but the amount of blood loss was small. It is important to understand that because the venous wall is thin, unlike the arterial wall, the risk of perforation increases.…”

“…With respect to the indications for transvenous embolization, a nidus size of 3 cm or smaller, deep location, single drainer, and difficulty in transarterial approach have been reported. 8,9,17) Mendes et al reported a complete occlusion rate of 100% in cases with a 3 cm or smaller nidus with a single drainer, 75% in cases with a 3 cm or larger nidus, and 60% in cases with two or more drainers. 8) In our patient, we attempted curative transarterial embolization, but the nidus could not be completely occluded and microcatheter insertion into the remaining feeder artery was difficult.…”

“…Conversely, recently, a high occlusion rate was reported by transvenous embolization with Onyx, although the number of cases was limited. [7][8][9] Herein, we report a case of a patient with brainstem arteriovenous malformation that manifested as hemorrhage, which was resolved by transvenous embolization subsequent to transarterial embolization during the same session. Additionally, we have presented a review of the literature.…”

Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance

“…In the present study, we did not observe any significant change in the annual rate of complete obliteration and procedure-related complications since Onyx has become widespread in the endovascular treatment of bAVMs in Japan (data not shown). Moreover, the recent advances in the field of embolization techniques such as transvenous embolization 42 and the introduction of dual-lumen balloon microcatheters 43 or the detachable-tip microcatheters 44 for liquid embolic material are expected to improve the rate of nidus occlusion with fewer complications, though none are currently available in Japan.…”