Introduction Embolization of brain AVMs by injecting Ethylene Vinyl Alcohol Copolymer (Onyx) has been facilitated with dual lumen balloon micro-catheters. Balloon-assisted embolization can improve the efficacy of AVM embolization by preventing excessive reflux of Onyx. However, there have been instances of vessel rupture or microcatheter retention with use of the compliant balloon microcatheter. We hypothesized that using an extra-compliant balloon microcatheter (Scepter XC, Microvention, Tustin, CA) would result in less vessel trauma and prevent pial vessel rupture upon inflation, while retaining the advantages of balloon assisted Onyx embolization. Herein, we report our experience using an extra-compliant balloon microcatheter for embolization of brain AVMS.

Materials and Methods This retrospective study was performed by reviewing the medical records and imaging studies of all patients who underwent AVM embolization at our institution between June 2012 and March 2017.

Results The extra compliant balloon microcatheter was used for endovascular pre-operative/pre-radiosurgical embolization of brain AVMs in 31 patients (21 male and 10 female ) aged 44.3 + 16.7 years (range: 1-65 years) A total of 40 intracranial vessels (39 pial arteries and one pial vein) were catheterized for injection of Onyx through the balloon microcatheter in these patients. The balloon was not pre-inflated ex-vivo but simply purged of air to improve trackability.In all instances, the balloon microcatheter could be successfully advanced to the nidus of the AVM. A mean volume of 2.1 cc (Range= 0.65 -4.6 cc ) was injected at each instance. There was no incidence of vessel rupture, catheter retention, or stroke.

Conclusion The utilization of the extra-compliant balloon microcatheter results in safe and effective balloon assisted embolization. These results add to the growing experience of balloon assisted embolization for AVM treatment.

Disclosures: B. Jagadeesan: 2; C; Microvention, Medtronic. A. Grande: 2; C; Medtronic, Integra. R. Tummala: None.