Morphological studies of human arteriovenous malformations. Effects of isobutyl 2-cyanoacrylate embolization

Ten patients with symptomatic arteriovenous malformations (AVM's) underwent embolization with isobutyl 2-cyanoacrylate (Bucrylate) delivered via a mini-balloon catheter according to the protocol of George and Pevsner. These patients underwent surgical removal of their embolized AVM, and surgical specimens were evaluated by light and scanning electron microscopy. Ten other patients with AVM's underwent surgical resection without prior embolization, and these surgical specimens were evaluated in a similar manner. Results from this study indicate that Bucrylate incites an inflammatory response characterized by foreign-body giant cells. This reaction was present as early as 3 weeks after embolization and persisted in specimens resected almost 1 year after the last embolization. No such reaction was observed in unembolized AVM's. Both light and scanning electron microscopy demonstrated a lattice structure of the Bucrylate embolus within the AVM vessels. These studies also demonstrated micro-channels within the Bucrylate embolus and the presence of what appears to be normal red blood cells within the latticework of the embolus. Vascular endothelium not in direct contact with the Bucrylate embolus retains a normal morphology as revealed by scanning electron microscopy.