DOI QR코드

DOI QR Code

Coil-Protected Technique for Liquid Embolization in Neurovascular Malformations

  • Keun Young Park (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Jin Woo Kim (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Byung Moon Kim (Division of Interventional Neuroradiology and Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Dong Joon Kim (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Joonho Chung (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Chang Ki Jang (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Jun-Hwee Kim (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine)
  • 투고 : 2019.02.15
  • 심사 : 2019.05.09
  • 발행 : 2019.08.01

초록

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.

키워드

과제정보

This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1056).

참고문헌

  1. Kim DJ, Willinsky RA, Krings T, Agid R, TerBrugge K. Intracranial dural arteriovenous shunts: transarterial glue embolization--experience in 115 consecutive patients. Radiology 2011;258:554-561 https://doi.org/10.1148/radiol.10100755
  2. Carlson AP, Taylor CL, Yonas H. Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (onyx) arterial embolization as the primary modality: short-term results. J Neurosurg 2007;107:1120-1125 https://doi.org/10.3171/JNS-07/12/1120
  3. Van Dijk JM, TerBrugge KG, Willinsky RA, Farb RI, Wallace MC. Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke 2002;33:1578-1583 https://doi.org/10.1161/01.STR.0000018009.83713.06
  4. Sherif C, Gruber A, Bavinzski G, Standhardt H, Widhalm G, Gibson D, et al. Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment. Neuroradiology 2008;50:67-74 https://doi.org/10.1007/s00234-007-0303-4
  5. Nelson PK, Russell SM, Woo HH, Alastra AJ, Vidovich DV. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg 2003;98:498-506 https://doi.org/10.3171/jns.2003.98.3.0498
  6. Debrun GM, Aletich V, Ausman JI, Charbel F, Dujovny M. Embolization of the nidus of brain arteriovenous malformations with n-butyl cyanoacrylate. Neurosurgery 1997;40:112-120; discussion 120-121 https://doi.org/10.1227/00006123-199701000-00026
  7. Kim JW, Kim BM, Park KY, Kim DJ, Kim DI. Onyx embolization for isolated type dural arteriovenous fistula using a dual-lumen balloon catheter. Neurosurgery 2016;78:627-636 https://doi.org/10.1227/NEU.0000000000001069
  8. Cohen JE, Moscovici S, Itshayek E. The advantages of balloon assistance in endovascular embolization of spinal dural arteriovenous fistulas. J Clin Neurosci 2013;20:141-143 https://doi.org/10.1016/j.jocn.2012.09.004
  9. Spiotta AM, Hughes G, Masaryk TJ, Hui FK. Balloon-augmented Onyx embolization of a dural arteriovenous fistula arising from the neuromeningeal trunk of the ascending pharyngeal artery: technical report. J Neurointerv Surg 2011;3:300-303 https://doi.org/10.1136/jnis.2010.003095
  10. Rhim JK, Cho YD, Yoo DH, Kang HS, Cho WS, Kim JE, et al. Endovascular treatment of bilateral cavernous sinus dural arteriovenous fistula: therapeutic strategy and follow-up outcomes. Korean J Radiol 2018;19:334-341 https://doi.org/10.3348/kjr.2018.19.2.334
  11. Andreou A, Ioannidis I, Nasis N. Transarterial balloon-assisted glue embolization of high-flow arteriovenous fistulas. Neuroradiology 2008;50:267-272 https://doi.org/10.1007/s00234-007-0322-1
  12. Rangel-Castilla L, Barber SM, Klucznik R, Diaz O. Mid and long term outcomes of dural arteriovenous fistula endovascular management with Onyx. Experience of a single tertiary center. J Neurointerv Surg 2014;6:607-613 https://doi.org/10.1136/neurintsurg-2013-010894
  13. Zhao LB, Shim JH, Lee DG, Suh DC. Two microcatheter technique for embolization of arteriovenous fistula with liquid embolic agent. Neurointervention 2014;9:32-38 https://doi.org/10.5469/neuroint.2014.9.1.32
  14. Suh DC, Cho SH, Park JE, Liu H, Jung SC. Induced-wedge technique to improve liquid embolic agent penetration into spinal dural arteriovenous fistula. World Neurosurg 2016;96:309-315 https://doi.org/10.1016/j.wneu.2016.09.002
  15. Takasawa C, Seiji K, Matsunaga K, Matsuhashi T, Ohta M, Shida S, et al. Properties of N-butyl cyanoacrylate-iodized oil mixtures for arterial embolization: in vitro and in vivo experiments. J Vasc Interv Radiol 2012;23:1215-1221.e1 https://doi.org/10.1016/j.jvir.2012.06.022
  16. Guillevin R, Vallee JN, Cormier E, Lo D, Dormont D, Chiras J. N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae: CT evaluation, technical features, and outcome prognosis in 26 cases. AJNR Am J Neuroradiol 2005;26:929-935
  17. Su IC, terBrugge KG, Willinsky RA, Krings T. Factors determining the success of endovascular treatments among patients with spinal dural arteriovenous fistulas. Neuroradiology 2013;55:1389-1395 https://doi.org/10.1007/s00234-013-1285-z
  18. Gounis MJ, Lieber BB, Wakhloo AK, Siekmann R, Hopkins LN. Effect of glacial acetic acid and ethiodized oil concentration on embolization with N-butyl 2-cyanoacrylate: an in vivo investigation. AJNR Am J Neuroradiol 2002;23:938-944