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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results
1Department of Radiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, PA, USA.
Background And Purpose:
Prior to their relatively recent FDA approval, detachable balloons for endovascular arterial occlusion had been available on only a limited basis. We evaluated the feasibility of permanent endovascular carotid and vertebral artery occlusion using microcoils deployed with and without proximal flow arrest in 19 patients.
Methods:
Permanent endovascular occlusion was performed in 19 arteries of 19 patients. The treated lesions included nine aneurysms, one carotid-cavernous fistula/pseudoaneurysm, seven neoplasms, and two dissections. Nondetachable balloons were used to arrest proximal blood flow during occlusion of only six arteries. Anticoagulation (heparin, 5000 U IV) was used during occlusion of 18 arteries. Three to 88 coils were used per lesion. Complex fibered platinum microcoils were used for all cases, and GDCs were also used in two patients.
Results:
Sixteen patients had no new neurologic deficits after arterial occlusion. No patient had an acute event that suggested an embolic complication. Coils provided rapid and durable arterial occlusion in 17 patients. In both patients with acute carotid artery rupture, large numbers of coils placed during flow arrest failed to produce complete occlusion, which was accomplished subsequently with detachable balloons. One of these patients incurred a fatal hemispheric infarct after occlusion. One patient treated for a ruptured posterior inferior cerebellar artery aneurysm by vertebral artery occlusion continued to have progressive neurologic deficits. One patient with a cavernous aneurysm had upper extremity weakness and mild dysphasia 24 hours after internal carotid artery occlusion.
Conclusion:
In our small series, microcoils were found to be safe and effective for neurovascular occlusion. When both intravenous heparin (5000 U IV bolus) and heparinized catheter flush solutions (5000 U/L) are used, flow arrest during coil placement is unnecessary to prevent clinically apparent embolic complications.
