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

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

OBJECTIVETo evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).

METHODSThe clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.

RESULTSThe 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.

CONCLUSIONEndovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult

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

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

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

OBJECTIVETo introduce superselective endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations using absolute ethanol, and to assess the efficacy and complications of the method.

METHODSA retrospective review of patient medical and imaging records was performed. 8 patients (7 male, 1 female, 11-50 years) with craniofacial arteriovenous malformations underwent staged selective ethanol endovascular therapy (1-4 times, median 2 times). Clinical follow-up (8-24 months, mean 12.1 months) was performed in all patients, and results from imaging follow-up (2-6 months, mean 4.3 months) were available in 4 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms, as well as the degree of devascularization at follow-up angiography.

RESULTS16 sessions of selective ethanol endovascular therapy were performed in 8 patients. 5 of 8 patients were cured, 2 had improvement, 1 had no change. Selective ethanol endovascular therapy was considered effective in 7 patients (87.5%). 4 patients will need further treatment sessions for residual arteriovenous malformations. Blistering, superficial skin necrosis and transient hemolysis occurred in 4 of 8 patients. All the complications were healed with observation. No major complications occurred.

CONCLUSIONSuperselective ethanol endovascular therapy under digital subtraction angiography has the potential for cure of craniofacial arteriovenous malformations and is able to obtain excellent cosmetic results, and with acceptable risk of complications.

Adolescent ; Adult ; Angiography, Digital Subtraction ; Arteriovenous Malformations ; therapy ; Child ; Ethanol ; administration & dosage ; Face ; blood supply ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the clinical and pathological characteristics of brain arteriovenous malformations (BAVM) embolized with the non-adhesive aqueous embolic agent Onyx and evaluate its application in comprehensive treatment of BAVM.

METHODSThirty-four patients underwent BAVM embolization using Onyx, and their clinical manifestations, architecture of the malformed vessels, emblization procedure, and complications associated with the procedures were recorded. The resected tissues after embolization with Onyx were observed with electron microscope, and the prognosis of the patients was estimated with modified Rankin Score (mRS).

RESULTSThese patients included 21 male and 13 female patients with a mean age of 30.45-/+11.81 years and an estimated mean size of the nidus of 3.98-/+1.43 cm. The patients received a total of 52 endovascular treatment procedures with Onyx to embolize 86 feeding pedicals, which resulted in an average estimated size reduction of the nidus of (72.35-/+21.26)%. Complications associated with the procedure occurred in 7 patients, and 23 patients received surgical resection or radiosurgery after embolization. Follow-up of the patients for 6 months to 4 years showed that the mRS was below 3 in 32 cases and > or =3 in 2 cases. Vasodilatation, brain tissue edema surrounding the nidus, and inflammatory cell infiltration were observed in the resected tissues after embolization. In some major feeding pedicals, thrombus recanalization was observed after embolization with Onyx (diameter> or =3 mm).

CONCLUSIONEndovascular treatment of BAVM with Onyx can achieve high occlusion rate, enhance the safety of operation and radiosurgery, and improve the clinical prognosis of the patients.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations ; surgery ; therapy ; Male ; Middle Aged ; Polyvinyls ; therapeutic use ; Young Adult

A 12-week-old baby with a vein of Galen aneurysmal malformation (VGAM) was successfully treated with performing transarterial microcatheter-directed embolization with Berenstein Liquid Coils and n-butyl cyanoacrylate in the feeding arteries. Post-procedure angiography showed a marked decrease of the blood flow into the dilated vein of Galen. Three months later, follow-up angiography showed that the vein of Galen aneurysmal malformation had totally disappeared, and the baby recovered very well without any sequelae. We report here on this interesting case along with a review of the relevant literature, and we aim to enhance physicians' awareness of the treatment for VGAMs.
Catheterization/*instrumentation ; Cerebral Angiography ; *Cerebral Veins ; Cyanoacrylates/*administration & dosage ; Embolization, Therapeutic/*instrumentation/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/diagnosis/*therapy ; Magnetic Resonance Imaging ; Male

OBJECTIVETo report our clinical experience of using Onyx, a new liquid embolic agent, to treat cerebral arteriovenous malformations (AVMs) as well as its efficacy.

METHODSSeventy cases were placed with 6F sheath in the femoral artery after Seldinger puncture and 6F guiding catheter was introduced into the internal carotid artery or vertebral artery, then a microcatheter was navigated into the nidus of AVMs. Slow injection of Onyx under fluoroscopic control was performed to embolize cerebral AVMs using the "plug and push" technique.

RESULTSThirteen AVM cases (18.6%) were totally occluded by Onyx and 5 cases of which didn't recurrence at 6-month after operation. Thirty-eight cases (54.3%) were subtotally occluded, while another 19 cases (27.1%) were partially embolized. Severe cerebral hemorrhage occurred in 4 cases, 2 of which had mild to severe hemiplegia after operation, and one died. Mild hemiplegia was also found in 1 case due to functional area embolization, and visual field deficit in 2 cases.

CONCLUSIONSOnyx has unique and distinctive superiority in treating cerebral AVMs. Nonetheless, the correct embolization technique should be learned to achieve good clinical results and avoid complications.

Adolescent ; Adult ; Child ; Dimethyl Sulfoxide ; administration & dosage ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; Treatment Outcome