Embolization of a brain arteriovenous malformation using combined transarterial and transvenous dual-lumen...

For brain arteriovenous malformations (BAVMs), in which transarterial embolization (TAE) is not feasible, transvenous embolization (TVE) offers an alternative. In TVE, the reverse "pressure cooker" technique using coils or glue as a venous plug is necessary. A dual-lumen mini-balloon catheter can be used in place of the coils or glue as a venous plug, but this has rarely been reported. An 18-year-old male experienced rebleeding due to previous incomplete TAE for a ruptured BAVM. On admission, physical examination did not detect positive signs, but computed tomography revealed right frontal lobe rebleeding. Digital subtraction angiography (DSA) revealed a frontal lobe residual BAVM supplied by the distal anterior cerebral artery (ACA) and drained via the anterior cerebral vein (ACV), the basal vein of Rosenthal, and the vein of Galen into the straight sinus. After a transvenous TJWY dual-lumen mini-balloon catheter (TJWY Medical, Beijing, China) reached the origin of the ACV near the BAVM. A second transarterial TJWY dual-lumen mini-balloon catheter was placed across the origin of the feeding artery from the ACA. Once both balloons were inflated, TVE was performed by injecting EVAL-I (SUCCESS, Shandong, China) through the balloon in the ACV. The residual BAVM was obliterated. Postoperatively, the patient had no new neurologic deficits and resumed his studies. Three-month follow-up DSA confirmed BAVM cure. This report shows that combining transarterial and transvenous dual-lumen mini-balloon catheters may be feasible when performing TVE for a BAVM. EVAL-I is a suitable embolic agent for TVE.