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Spinal epidural arteriovenous fistula embolization with ethylene vinyl alcohol (EVOH) copolymer using the Scepter Mini dual-lumen balloon
  1. Frédéric Clarençon1,2,
  2. Eimad Shotar1,
  3. Arnaud Pouvelle1,
  4. Kevin Premat1,2,
  5. Stéphanie Lenck1,
  6. Mehdi Drir3,
  7. Gonzague Guillaumet4,
  8. Elisabeth Maillart5,
  9. Nader-Antoine Sourour1
  1. 1 Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France
  2. 2 Sorbonne University, Paris, France
  3. 3 Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France
  4. 4 Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France
  5. 5 Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France
  1. Correspondence to Dr Frédéric Clarençon, Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l’Hôpital, 75013 Paris, France; fredclare5{at}gmail.com

Abstract

Left unattended, spinal epidural arteriovenous fistulas (EAVFs) have a potentially severe clinical course. Embolization using ethylene vinyl alcohol (EVOH) copolymers through regular dual-lumen balloons has emerged as a potential option for the treatment of spinal arteriovenous (AV) fistulas;1–3 the main issue with this technique is the navigability of these balloons. The Scepter Mini is a low-profile, dual-lumen balloon, which may be helpful for EVOH embolization of spinal AV fistulas, as it may help to overcome the navigation drawbacks. In this technical video, we present a case of EVOH embolization of a right T6 spinal EAVF through a Scepter Mini balloon. Of note, particular attention should be paid to radiculomedullary arteries arising at the same level or at adjacent levels to avoid severe neurologic complications related to uncontrolled migration of the liquid embolic agent. Moreover, excessive use of embolic material should be avoided to prevent spinal cord compression (video 1).

Video 1
  • fistula
  • liquid embolic material
  • vascular malformation

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Footnotes

  • Contributors FC: manuscript redaction, video preparation. ES: manuscript preparation, critical review of the manuscript. AP: data collection, critical review of the manuscript. KP: critical review of the manuscript. SL: critical review of the manuscript. MD: critical review of the manuscript. GG: data collection. EM: 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 lectures; unrelated to the study), Codman Neurovascular, and Microvention (core lab; unrelated to the study). N-AS is a consultant for Medtronic, Balt Extrusion, and Microvention. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings reported in this article. This article has not received any financial support from industry.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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