PT  - JOURNAL ARTICLE
AU  - William O Bank
AU  - Andrew B Stemer
AU  - Rocco A Armonda
AU  - Randy S Bell
TI  - Intermittent balloon occlusion to favor nidal penetration during embolization of arteriovenous malformations: a technique modification
AID  - 10.1136/neurintsurg-2012-010637.rep
DP  - 2014 May 01
TA  - Journal of NeuroInterventional Surgery
PG  - e28--e28
VI  - 6
IP  - 4
4099  - http://jnis.bmj.com/content/6/4/e28.short
4100  - http://jnis.bmj.com/content/6/4/e28.full
SO  - J NeuroIntervent Surg2014 May 01; 6
AB  - 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.