RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd.
SP e28
OP e28
DO 10.1136/neurintsurg-2012-010637.rep
VO 6
IS 4
A1 William O Bank
A1 Andrew B Stemer
A1 Rocco A Armonda
A1 Randy S Bell
YR 2014
UL http://jnis.bmj.com/content/6/4/e28.abstract
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.