Improved technique for liquid embolization of cerebral arteriovenous malformation: catheter-tip position and flow...

This paper outlines the problems currently limiting the success and safety of embolization of cerebral arteriovenous malformations (AVMs) based upon the experiences of 110 cases. In cases where liquid embolic material was deposited mainly in arterial feeders, there was a reconstitution of the nidus through residual primary feeders and recruitment of blood flow via collateral tracts. A recent improvement of flexible microcatheters with minimal friction has made it possible to place the tip of a microcatheter into the nidus with greater success and safety. In order to obtain better filling of the AVM nidus and slower penetration to the draining veins, it is important to perform a temporary balloon occlusion of another main feeding pedicle to reverse the dynamic balance in favor of the pedicle being injected. In order to successfully occlude arteriovenous shunts in the nidus, appropriate flow control and optimal setting time of n-butyl-2 cyanoacrylate have prime importance.