Korean J Radiol.  2019 Aug;20(8):1285-1292. 10.3348/kjr.2019.0127.

Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations

Affiliations
  • 1Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 2Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 3Division of Interventional Neuroradiology and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. bmoon21@hanmail.net

Abstract


OBJECTIVE
To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations.
MATERIALS AND METHODS
Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated.
RESULTS
Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%).
CONCLUSION
The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

Keyword

Arteriovenous fistula; Arteriovenous malformation; Embolization; NBCA; Onyx

MeSH Terms

Angiography
Arteries
Arteriovenous Fistula
Arteriovenous Malformations
Cyanoacrylates
Follow-Up Studies
Humans
Methods
Punctures
Radiosurgery
Retrospective Studies
Cyanoacrylates
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