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Transvenous Embolization Technique for Brain Arteriovenous Malformations.

Muhammad Waqas¹, Ammad A Baig¹, Elad I Levy²

¹Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA.

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Summary

Transvenous embolization offers a curative option for small arteriovenous malformations (AVMs). Controlled hypotension via pacing and adenosine aids embolization for high obliteration rates.

Keywords:

Brain arteriovenous malformation Rapid ventricular pacing Transient transvenous pacing Transvenous embolization technique

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Area of Science:

Interventional Neuroradiology
Vascular Surgery
Cardiology

Background:

Arteriovenous malformations (AVMs) pose treatment challenges, especially those with deep locations or difficult arterial feeders.
Transvenous embolization is a key therapeutic strategy for select AVMs.
Controlling arterial inflow is crucial for successful embolization and nidus permeation.

Purpose of the Study:

To present a novel method for controlling arterial inflow during transvenous embolization of AVMs.
To highlight the efficacy of transient controlled hypotension induced by transvenous pacing and adenosine.

Main Methods:

Transvenous embolization procedure targeting small AVMs with favorable anatomy.
Induction of transient controlled hypotension using transvenous rapid ventricular pacing and adenosine.
Utilizing a hypercompliant balloon or systemic hypotension for arterial inflow control.

Main Results:

The described method facilitates successful navigation of the draining vein and embolization.
Achieving transient controlled hypotension enhances embolizate permeation into the AVM nidus.
This multidisciplinary approach demonstrates high chances of complete AVM obliteration.

Conclusions:

Transvenous embolization, particularly with controlled hypotension, is a potentially curative treatment for specific AVMs.
The combination of transvenous pacing and adenosine offers an effective means to manage arterial inflow.
A multidisciplinary approach is essential for optimizing outcomes in AVM embolization.