Endovascular embolization has increasingly been applied for brain arteriovenous malformation (BAVM). With our better understanding of BAVM and the continuous improvement of micro-catheter technology and embolic materials, the therapeutic effectiveness has constantly increased. This paper reviews recent advances in research on BAVM and the application of endovascular embolization.
Embolization, Therapeutic ; Humans ; Intracranial Arteriovenous Malformations ; therapy

In recent two years, new reports about concepts, technologies, materials, and especially new clinical trial results for endovascular treatment of cerebrovascular diseases, has provided tremendous promise for further progress. Mechanical thrombectomy becomes a guideline-recommended therapy for acute ischemic stroke patients with large vessel occlusion, which is considered as a landmark event. The superiority of endovascular coiling over neurosurgical clipping has been further proved for intracranial aneurysm. New devices are constantly developing for aneurysm occlusion. For brain arteriovenous malformation, application of detachable-tip microcatheters improves safety of embolization procedure, and successful transvenous embolization has been also achieved in a few cases. Long-term result of carotid stenting for symptomatic patients has been proved to be noninferior to carotid endarterectomy. Meanwhile, some new trials only obtain negative results, for example, endovascular stenting for intracranial or vertebral artery stenosis both show worse outcomes compared with medical therapy alone. More advancements and investigations are needed.
Embolization, Therapeutic ; instrumentation ; Endarterectomy, Carotid ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents ; Stroke ; therapy ; Thrombectomy ; Vertebrobasilar Insufficiency ; therapy

Pulsatile tinnitus is a rarely occurring symptom of vascular origin. Most frequently, the symptoms are due to an arteriovenous malformation, to a tumor of the jugular glomus or to a local arterial stenosis. A 39-yr-old Korean male suffering from pulsatile tinnitus of the left ear was diagnosed to have dural arteriovenous malformation of the jugular bulb. Magnetic resonance imaging and angiography revealed a high-velocity vascular lesion encroaching the internal jugular vein and sigmoid sinuses. Digital subtraction angiography demonstrated a dural arteriovenous malformation involving the jugular bulb. The arterial supply was from the neuromeningeal branch of the left ascending pharyngeal artery and inferior tympanic artery. Stenosis of the left jugular vein caused retrograde venous drainage through the contralateral transverse sinus. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of N-butylcyanoacrylate and lipiodol. In postembolization period, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared.
Adult ; *Embolization, Therapeutic ; Human ; Intracranial Arteriovenous Malformations/*therapy ; Jugular Veins/*abnormalities ; Male ; Tinnitus/etiology

BACKGROUNDNon-adhesive liquid embolic agents are increasingly gaining importance in the embolization of cerebral arteriovenous malformations (AVMs). We investigated the use of poly (N-isopropylacrylamide) (PNIPAM) as a non-adhesive embolic agent in swine rete mirabile.

METHODSThe PNIPAM hydrogel was mixed with iohexol and embolization was performed in swine rete mirabile in 30 animals. The microcatheter was examined after embolization. Follow-up angiography was performed for embolic efficacy after embolization. Embolized retia were examined histopathologically, and the alterations of inside rete and surrounding tissue were observed.

RESULTSThe copolymer hydrogel was used for rete embolization in 30 swine, 28 swine survived the procedure, 2 swine died, 1 swine died of cerebrum infarction and the other died of embolic agent reflux into the occipital artery. The inside wall of the microcatheter was smooth, without copolymer adhering to it. Follow-up angiography was performed in 22 swine, there was no rete recanalization in 20 swine and partial rete recanalization in 2 swine because of the trunk embolization of ascending pharyngeal arteries. Histopathologically, the copolymer was found diffused into vessels of 100 - 150 microm in diameter. In acute group, neutrophils scattered surrounding the copolymer and endothelial integrity was observed, without endothelial denuding and necrosis. In subacute and chronic groups, the copolymer was found inside retia, a few mononuclear cells and eosinocytes scattered inside and surrounding it. The muscular layer was loosened with most muscular nuclei degraded.

CONCLUSIONExperimental rete embolization with PNIPAM, made radiopaque with iohexol, is technically feasible in swine. Because of its properties, PNIPAM has great potential as a therapeutic non-adhesive embolic agent.

Acrylic Resins ; Animals ; Embolization, Therapeutic ; methods ; Intracranial Arteriovenous Malformations ; therapy ; Swine

Adult ; Child ; Embolization, Therapeutic ; methods ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.
Adolescent ; Arteriovenous Fistula/*radiography/*therapy ; Cerebral Angiography ; Cerebral Hemorrhage/*radiography/*therapy ; Diagnosis, Differential ; Embolization, Therapeutic/*methods ; Humans ; Intracranial Arteriovenous Malformations/*radiography/*therapy ; Male ; Tomography, X-Ray Computed/*methods

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.
Arteriovenous Fistula/*diagnosis/therapy ; *Cavernous Sinus/radiography ; Embolization, Therapeutic/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Posterior Cerebral Artery ; Temporal Lobe/blood supply

OBJECTIVESTo summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects.

METHODSThe clinical data from 135 patients with DAVFs were analyzed retrospectively.

RESULTSSeventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage.

CONCLUSIONSClinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.

Adolescent ; Adult ; Aged ; Arteriovenous Fistula ; congenital ; diagnosis ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Arteriovenous Malformations ; diagnosis ; therapy ; Male ; Middle Aged

We present a case in which an arterial rupture occurring during embolization of an arteriovenous malformation of the left occipital lobe with a flow-directed micro-catheter,was successfully sealed with a small amount of glue. We navigated a 1.8-Fr Magic catheter through the posterior cerebral artery, and during superse-lective test injection, extravasation was observed at the parieto-occipital branch. The catheter was not removed and the perforation site was successfully sealed with a small amount of glue injected through the same catheter. Prompt recogni-tion and closure of the perforation site is essential for good prognosis.
Adult ; Case Report ; Cerebral Arteries/*injuries ; Embolization, Therapeutic/*adverse effects ; *Enbucrilate ; Human ; Intracranial Arteriovenous Malformations/*therapy ; *Iodized Oil ; Male ; Rupture

Arteriovenous Fistula ; therapy ; Brain Ischemia ; therapy ; Carotid-Cavernous Sinus Fistula ; therapy ; Cerebrovascular Disorders ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents