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Embolization of a spinal dural arteriovenous fistula with ethylene-vinyl alcohol copolymer (Onyx) using a dual-lumen microballoon catheter and buddy wire technique.

ABSTRACT: N-butyl 2-cyanoacrylate (NBCA) remains the standard embolic agent for spinal dural arteriovenous fistula (SDAVF) treatment. Treatment of SDAVF with ethylene-vinyl alcohol copolymer (Onyx, ev3-Covidien, Irvine CA, USA) is currently not well established. Although several cases have reported the use of Onyx to embolize an intracranial dural arteriovenous fistula using a dual-lumen microballoon catheter, Onyx embolization of an SDAVF using a dual-lumen microballoon catheter has not been reported.We treated a 57-year-old man with an SDAVF using a dual-lumen microballoon catheter and buddy wire technique to perform transarterial Onyx embolization via the left sixth intercostal artery.Onyx embolization using a dual-lumen microballoon catheter was effective. Furthermore, the buddy wire technique was useful for providing rigid support of the microcatheter in a narrow and tortuous intercostal artery.

SUBMITTER: Nakae R

PROVIDER: S-EPMC5551288 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Updates in the management of cranial dural arteriovenous fistula.

Project description:Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.

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Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography.

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| S-EPMC8113326 | biostudies-literature

Potential biomarkers of spinal dural arteriovenous fistula: C4BPA and C1QA.

Project description:Background and purposeA major challenge in spinal dural arteriovenous fistula (SDAVF) is timely diagnosis, but no specific predictive biomarkers are known.MethodsIn the discovery cohort (case, n = 8 vs. control, n = 8), we used cerebrospinal fluid (CSF) and paired plasma samples to identify differentially expressed proteins by label-free quantitative proteomics. Further bioinformatics enrichment analyses were performed to screen target proteins. Finally, it was validated by ELISA in two of the new cohorts (case, n = 17 vs. control, n = 9), and univariate analysis, simple linear regression, and receiver operator characteristic (ROC) curve analysis were performed to evaluate the diagnostic potential.ResultsIn the discovery cohort, the most overexpressed proteins were APOB and C4BPA in CSF samples of patients. The GO/KEGG enrichment analysis indicated that the upregulated proteins were mainly involved in the acute inflammatory response and complement activation. Hub-gene analysis revealed that APP might be the key protein in the molecular interaction network. In the validation cohort, C4BPA and C1QA were significantly overexpressed in the CSF of patients, averaging 3046.9 ng/ml and 2167.2 ng/ml, respectively. Simple linear regression demonstrated that levels of C1QA and C4 were positively correlated with total protein in CSF (R2 = 0.8021, p = 0.0005; R2 = 0.7447, p = 0.0013). The areas under the ROC curves of C4BPA and C1QA were 0.86 and 1.00, respectively.ConclusionsThis study was the first to identify C4BPA and C1QA as potential biomarkers for the diagnosis of SDAVF and revealed that complement pathway activation might be one of the molecular mechanisms for venous hypertension myelopathy.

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Contrast-Enhanced Magnetic Resonance Imaging Suggested a Possibility of Transvenous Embolization in the Superior Petrosal Sinus Dural Arteriovenous Fistula: A Case Report.

Project description:ObjectiveSuperior petrosal sinus dural arteriovenous fistula (SPS-DAVF) is a rare subtype of intracranial DAVF that sometimes leads to hemorrhagic symptoms following deep venous drainage. Here we report the case of SPS-DAVF with retrograde venous reflux to the cerebellar vein. Preoperative contrast-enhanced MRI was a decisive factor in a safe and effective treatment.Case presentationA 37-year-old woman was referred to our hospital with abnormal MRI findings, which was performed when she had a mild headache during her check-up. DSA revealed left-sided SPS-DAVF, which was diagnosed as Cognard type IIb. Both CTA and DSA could not detect the whole SPS but only the shunt pouch. Using contrast-enhanced MRI, we were able to visualize the presence of the SPS and its continuity within the shunt pouch. 3D-T1 turbo spin echo (SPACE) showed a low-intensity area in the SPS, which was not seen in the 3D-T1 fast field echo (FFE). During the procedure, there was a point where it was difficult to advance the microcatheter, which coincided with the low-intensity area. We achieved effective transvenous embolization from the occluded venous access by devising a surgical technique.ConclusionIn addition to the contrast-enhanced 3D-T1 FFE, 3D-T1 SPACE might provide beneficial information for endovascular therapy in the evaluation of venous sinuses, which could not be detected by standard examinations.

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Angioarchitecture of Spinal Dural Arteriovenous Fistula - Evaluation with 3D Rotational Angiography.

Project description:PURPOSE:The complex angioarchitecture of spinal dural arteriovenous fistulas (SDAVFs) sometimes preclude angiographic analyses or superselective procedures. Therefore, the effectiveness of 3 dimensional rotational angiography (3DRA) as a detailed imaging technique for SDAVFs was evaluated. MATERIALS AND METHODS:Of 57 patients with spinal vascular malformations, recent 13 SDAVF patients underwent 3DRA. The advantage of 3DRA compared to digital subtraction angiography (DSA) in imaging SDAVF was assessed. Angioarchitecture of SDAVF was focused on location, number, and course of feeders and draining vein. Appropriate angled views were also selected to reveal the segmental artery and feeders. RESULTS:3DRA technique provided additional information for imaging evaluation of SDAVFs compared to DSA; the presence of multiple feeders, including their transdural portions, as well as their courses. The contralaterally angled anterior-oblique-caudal (spider) view showed the radicular feeder by separating the intercostal artery and the dorsal muscular branch. The bottom-to-up (tunnel) view was useful for revealing the location (ventral vs. dorsal) including sharp medial turn of the dural feeder. The dual mode, which displays both vessels and bones, revealed the course of the feeders and the fistula related to the spinal bony column. CONCLUSION:Because spinal vasculature overlaps in DSA, 3DRA revealed additional information for evaluations of the number and transdural course of fistular feeders in SDAVFs, and it offers working angles to obtain appropriate views.

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Successful endovascular treatment of ruptured bilateral ophthalmic frontal dural arteriovenous fistula.

Project description:Bilateral ophthalmic-ethmoidal dural arteriovenous fistulas (DAVFs) are extremely rare and may present as complex lesions. These DAVFs are associated with high risk of intracranial hemorrhage but can be presented with ocular symptoms, cranial nerve palsy or epistaxis. Endovascular approaches have been used to manage an increasing proportion of complex intracranial DAVFs safely and with good clinical results. We present a patient with subdural hematoma and severe epistaxis due to ruptured bilateral ophthalmic-ethmoidal DAVF that was successfully treated by transarterial embolization with precipitating hydrophobic injectable liquid.

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Project description: Not available

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Endovascular Treatment of Medial Tentorial Dural Arteriovenous Fistula Through the Dural Branch of the Pial Artery.

Project description:Background: Tentorial dural arteriovenous fistula is a rare subtype of intracranial dural arteriovenous fistula (DAVF) with a deteriorating natural course, which may be attributed to its pial angioarchitecture. TDAVF often harbors feeders arising from pial arteries (FPAs). Reports have revealed that, if these feeders are not obliterated early, the restricted venous outflow during the embolization process may cause upstream congestion in the fragile pial network, which increases the risk of hemorrhagic complications. Because most reported cases of TDAVF were embolized through feeders from non-pial arteries (FNPAs), little is known of the feasibility of direct embolization through FPAs. Methods: We present three patients with medial TDAVFs that were embolized through the dural branches of the posterior cerebral and superior cerebellar arteries. Findings from brain magnetic resonance imaging, computed tomography, angiography, and clinical outcomes are described. Furthermore, we performed a review of the literature on TDAVFs with FPAs. Results: The fistulas were completely obliterated in two patients; both recovered well with no procedure-related complications. The fistula was nearly obliterated in one patient, who developed left superior cerebellum and midbrain infarct due to the reflux of the embolizer into the left superior cerebellar artery. Including our cases, eight cases of TDAVFs with direct embolization through the FPAs have been reported, and ischemic complications occurred in three (37.5%). Conclusions: Advancing microcatheter tips as close to the fistula point as possible and remaining highly aware of potential embolizer flow back into the pial artery are key factors in achieving successful embolization. Balloon-assisted embolization may be an option for treating TDAVFs with FPAs in the future.

| S-EPMC8710483 | biostudies-literature

Onyx (Ethylene-vinyl Alcohol Copolymer) in Peripheral Applications.

Project description:Onyx is a nonadhesive liquid embolic agent approved for the treatment of brain arteriovenous malformations. Here, the use of Onyx is discussed in different peripheral procedures. The Onyx's features, its manipulation, technical details, tips, and tricks are presented followed by illustrative cases.

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Secondary ocular hypertension due to tentorial dural arteriovenous fistula: a case report.

Project description:BackgroundTentorial dural arteriovenous fistulas (TDAVFs) are abnormal shunts between meningeal arteries and the intradural venous system located in the tentorial dura mater, which typically manifest with haemorrhage or progressive neurological disorders. TDAVFs with pure ocular presentation have been rarely reported.Case presentationsThe case of a 56-year-old man presented with unilateral eye redness, proptosis and elevated intraocular pressure was reported herein, which was caused by a TDAVF. The fistula was fed by the left posterior cerebral artery and posterior meningeal artery. The drainage was into the basal vein and internal cerebral veins, which led the arterial blood flow forward to the left superior ophthalmic vein directly. The redundant blood flow caused the rise of episcleral venous pressure, leading to the clinical presentations. Gamma knife radiosurgery was performed then considering the delicate vascular structure and its deep location. The corkscrew hyperaemia was gradually alleviated after the surgery, but the intraocular pressure remained elevated at follow-ups.ConclusionDural arteriovenous fistulas which are not directly connected to cavernous sinus could cause ocular presentations like proptosis, eye redness and ocular hypertension.

| S-EPMC10496288 | biostudies-literature

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