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Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations.
Korean J Radiol. 2019 08; 20(8):1285-1292.KJ

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31339016

Citation

Park, Keun Young, et al. "Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations." Korean Journal of Radiology, vol. 20, no. 8, 2019, pp. 1285-1292.
Park KY, Kim JW, Kim BM, et al. Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations. Korean J Radiol. 2019;20(8):1285-1292.
Park, K. Y., Kim, J. W., Kim, B. M., Kim, D. J., Chung, J., Jang, C. K., & Kim, J. H. (2019). Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations. Korean Journal of Radiology, 20(8), 1285-1292. https://doi.org/10.3348/kjr.2019.0127
Park KY, et al. Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations. Korean J Radiol. 2019;20(8):1285-1292. PubMed PMID: 31339016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations. AU - Park,Keun Young, AU - Kim,Jin Woo, AU - Kim,Byung Moon, AU - Kim,Dong Joon, AU - Chung,Joonho, AU - Jang,Chang Ki, AU - Kim,Jun Hwee, PY - 2019/02/15/received PY - 2019/05/09/accepted PY - 2019/7/25/entrez PY - 2019/7/25/pubmed PY - 2020/7/7/medline KW - Arteriovenous fistula KW - Arteriovenous malformation KW - Embolization KW - NBCA KW - Onyx SP - 1285 EP - 1292 JF - Korean journal of radiology JO - Korean J Radiol VL - 20 IS - 8 N2 - 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. SN - 2005-8330 UR - https://www.unboundmedicine.com/medline/citation/31339016/Coil_Protected_Technique_for_Liquid_Embolization_in_Neurovascular_Malformations_ L2 - https://www.kjronline.org/DOIx.php?id=10.3348/kjr.2019.0127 DB - PRIME DP - Unbound Medicine ER -