Intranidal direct arteriovenous (AV) shunts are rarely observed in brain arteriovenous malformations (bAVMs).1 The endovascular treatment of such direct AV shunts may be challenging. Indeed, there is a significant risk of venous migration of the embolic agent used to occlude the AV shunt, leading to a subsequent risk of nidus bleeding due to impairment (slowdown or even occlusion) of the bAVM’s venous drainage.2
Various endovascular techniques have been developed to avoid the risk of such inopportune impairment of the venous drainage during attempts to occlude a direct intranidal AV shunt.3–5 We present in this Technical Video (video 1) different endovascular strategies to occlude such direct AV shunts using dual-lumen balloons with various liquid embolic agents, or using occlusion plugs.
- arteriovenous malformation
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Contributors FC: manuscript redaction, video preparation. ES: manuscript preparation, critical review of the manuscript. SL: critical review of the manuscript. MA: data collection, critical review of the manuscript. KP: critical review of the manuscript. A-LB: critical review of the manuscript. N-AS: data collection, critical review of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests FC reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; unrelated to the study), Codman Neurovascular, and Microvention (core lab; unrelated to the study). N-AS is consultant for Medtronic, Balt Extrusion, and Microvention.
Provenance and peer review Not commissioned; externally peer reviewed.