RT Journal Article
SR Electronic
T1 Experimental investigation of transvenous embolization of arteriovenous malformations using different in vivo models
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2022-018894
DO 10.1136/neurintsurg-2022-018894
A1 Dominik F Vollherbst
A1 Matthias Hantz
A1 Niclas Schmitt
A1 Thuy D Do
A1 Ulf Neuberger
A1 Hans U Kauczor
A1 Martin Bendszus
A1 Christof M Sommer
A1 Markus A Möhlenbruch
YR 2022
UL http://jnis.bmj.com/content/early/2022/05/24/neurintsurg-2022-018894.abstract
AB Background Transvenous embolization (TVE) is an emerging technique for the endovascular treatment of cerebral arteriovenous malformations (AVMs). The aim of this study was to investigate two in vivo AVM models and to assess TVE techniques using these models.Methods Blood flow in the porcine rete mirabile (RM) was modified by either creating a carotid–jugular fistula or by placing a balloon guide catheter in the carotid artery. The RM was embolized with precipitating hydrophobic injectable liquid (PHIL) 25% via transarterial embolization (TAE; control group) and compared with TVE applying the transvenous retrograde pressure cooker technique and TVE using a Woven EndoBridge (WEB) device for flow control (n=6, respectively). The embolization extent (penetration of the RM), the number of events of reflux or embolization distal to the RM and the procedure times were assessed.Results The modified RM could be successfully used for embolization in all cases. There were no significant differences regarding the outcome parameters between the two AVM models (fistula or balloon). TVE using the pressure cooker technique led to a higher extent of embolization (median 98.8% vs 63.5%; p=0.008), a lower number of reflux or distal embolization events (p<0.001) and a shorter procedure time (p<0.001) compared with conventional TAE. TVE using a WEB device for flow control was technically feasible and achieved a moderate extent of embolization (median 83.8%).Conclusion After surgical or endovascular modification, the porcine RM is a feasible in vivo AVM model for the investigation of TVE techniques. TVE using the pressure cooker technique is superior to conventional TAE in this experimental model.All data relevant to the study are included in the article or uploaded as supplemental information.