TY - JOUR T1 - Intermittent balloon occlusion to favor nidal penetration during embolization of arteriovenous malformations: a technique modification JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - e28 LP - e28 DO - 10.1136/neurintsurg-2012-010637.rep VL - 6 IS - 4 AU - William O Bank AU - Andrew B Stemer AU - Rocco A Armonda AU - Randy S Bell Y1 - 2014/05/01 UR - http://jnis.bmj.com/content/6/4/e28.abstract N2 - 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. ER -