Dynamic (live) 3D roadmap as navigational tool in multiplug brain arteriovenous malformation embolization: technical...

Area of Science:

• Interventional Neuroradiology
• Vascular Neurosurgery
• Medical Imaging

Background:

• Brain arteriovenous malformations (bAVMs) are complex vascular lesions requiring diverse treatment modalities.
• Endovascular embolization is a key treatment, but achieving complete obliteration can be challenging, with success rates varying based on Spetzler-Martin (SM) grades.

Purpose of the Study:

• To illustrate the utility of 3D rotational angiography and dynamic 3D roadmap functions in endovascular bAVM treatment.
• To assess the impact of dynamic 3D roadmaps on microcatheter navigation and procedural efficiency.

Main Methods:

• Utilized dynamic (live) 3D roadmap functions derived from 3D rotational angiography during endovascular embolization of bAVMs.
• Employed dynamic 3D roadmaps for precise microcatheter and guidewire navigation to target bAVM feeders.

Main Results:

• Dynamic 3D roadmaps significantly aided microcatheter navigation, reducing the need for repeated 2D angiograms and C-arm repositioning.
• The technique was associated with reduced radiation dose and no observed complications like misalignment, perforation, or thromboembolism in 21 cases.

Conclusions:

• Dynamic 3D roadmaps are highly effective for navigating complex angioarchitecture and achieving multiple-feeder cannulation in bAVM embolization.
• This technology enhances intraprocedural orientation and contributes to improved complete angiographic obliteration rates, particularly with multi-plug embolization techniques.