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Case report
Intermittent balloon occlusion to favor nidal penetration during embolization of arteriovenous malformations: a technique modification
  1. William O Bank1,
  2. Andrew B Stemer1,
  3. Rocco A Armonda2,
  4. Randy S Bell2
  1. 1Interventional Radiology, Washington Hospital Center, Washington, DC, USA
  2. 2National Capital Neurosurgery Consortium, Walter Reed Military Medical Center, Bethesda, Maryland, USA
  1. Correspondence to Dr Andrew B Stemer, astemer{at}gmail.com

Abstract

Endovascular embolization of brain arteriovenous malformations (AVMs) has improved with liquid occlusive agents, but flow-related and anatomic restrictions limit endovascular capabilities. AVM compartments supplied by leptomeningeal networks and feeding arteries too small and/or tortuous for safe catheterization are rarely penetrated by liquid occlusive agents. A case with both impediments prompted a novel solution. A balloon was inflated across the supply to a lenticulostriate feeder, thereby favoring penetration of the liquid occlusive agent, injected from a different feeding territory, back into the AVM compartment supplied by the temporarily occluded feeder. This technique may reduce the number of embolization stages in large high-flow AVMs and increase the likelihood of achieving complete occlusion. This technique is highly complex and requires meticulous monitoring of multiple events.

  • Arteriovenous Malformation
  • Balloon
  • Brain
  • Intervention
  • Liquid Embolic Material

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