PT  - JOURNAL ARTICLE
AU  - Christina Iosif
AU  - Jose Alberto Almeida Filho
AU  - Clara Esther Gilbert
AU  - Ali Nazemi Rafie
AU  - Suzana Saleme
AU  - Aymeric Rouchaud
AU  - Charbel Mounayer
TI  - Selective arterial temporary flow arrest with balloons during transvenous embolization for the treatment of brain arteriovenous malformations: a feasibility study with MRI-monitored adverse events
AID  - 10.1136/neurintsurg-2021-018097
DP  - 2022 Jan 12
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2021-018097
4099  - http://jnis.bmj.com/content/early/2022/01/12/neurintsurg-2021-018097.short
4100  - http://jnis.bmj.com/content/early/2022/01/12/neurintsurg-2021-018097.full
AB  - Background The technique of endovascular transvenous embolization for brain arteriovenous malformations (AVMs) has emerged in the last 8 years as a very promising therapeutic alternative for otherwise incurable cases. Selective temporary flow arrest during transvenous endovascular embolization (TFATVE) is a novel adaptation of our previously described transvenous approach, which employs hyper-compliant balloons intra-arterially for the selective occlusion of arterial feeders during ethylene vinyl copolymer (EVOH) injection, in order to reduce intra-nidal pressure and increase nidi occlusion rates.Methods We performed a feasibility study of the TFATVE technique between January 2016 and April 2020. Consecutive patients were included. All patients had at least one axial brain MRI or CT in the first 48 hours following intervention, and at least one brain MRI scan within the first postoperative month, in order to detect both silent and clinically evident adverse events. Patients’ demographics, angio-architectural characteristics, total injection and procedure times, angiographic and clinical outcomes were analyzed.Results 22 patients underwent TFATVE during transvenous endovascular treatment of brain AVMs. Among them, 86.4% were high Spetzler-Martin’s grade. Good clinical outcome (modified Rankin Scale <2) was achieved in 95.5% of the cases, with 0% of procedure-related mortality and 4.5% of clinically significant, procedure-related morbidity. Total occlusion of the nidus was achieved in >90% of the cases at the end of the procedure and angiographic stability was achieved in all cases; 100% of the cases had angiographic cure at follow-up.Conclusions TFATVE seems a safe and effective technique when conducted in carefully selected patients in highly specialized centers.