Article Figures & Data
Figures
- Fig 1.
A 35-year-old female patient who presented with left-sided headache and seizures. DSA revealed a left parietal (A and B) AVM supplied by the left MCA. The AVM was drained by the superficial cortical vein to the superior sagittal sinus. An Apollo microcatheter was positioned into a distal arterial feeder arising from the left MCA (C). A PHIL 30 plug was created with 2 rounds of injections (D, arrows). After 1.2 mL of PHIL 30 was injected into the AVM, embolization was continued with Menox 18 (E and F) to ensure successful distal and continuous penetration. No further proximal reflux was observed (G). Note the different radiopacities of the used liquid embolic agents (black arrows, Menox 18; white arrows, PHIL 30.) At the end of the procedure, 100% size reduction was achieved by delivering a total amount of 2.7 mL of embolic material from 1 feeder during 1 session (H).
- Fig 2.
Step-by-step embolization of a ruptured left-sided parietal AVM, Spetzler-Martin grade II. The tip of the microcatheter was placed into the nidus (A and B). Initial injections of PHIL 30 (C, D, E, F, G, and H; arrows) were needed to create a stable proximal plug. The embolic material was switched with Menox 18 to successfully achieve distal and continuous nidal penetration (I–L; arrows). Note the distal extent of the Menox agent (M, N, arrow) and the different radio-opacities of the applied LEAs.
Tables
Variable Value Age (yr) Mean 33.5 Median 42 Range 33–61 Sex (No.) (%) Male 25% (4) Female 75% (12) Presentation (No.) (%) Hemorrhage 75% (12) Neurologic deficit – Headache 12.5% (2) Epilepsy 12.5% (2) Asymptomatic – Size (%) (No.) ≤30 mm 75% (12) ≥30 mm 25% (4) No. of arterial feeders (%) Single 43.7% (7) Multiple 56.3% (9) Venous pattern (No.) (%) Superficial 68.7% (11) Deep 18.7% (3) Deep and superficial 12.5% (2) Spetzler-Martin score I 31.2% (5) II 37.5% (6) III 25% (4) IV 6.3% (1) mRS prior to embolization 1 68.7% (11) 2 25% (4) 3 6.3% (1) Note:—– indicates absence of particular determinant; mRS, modified ranking score.
Study Group (n= 16) Value Applied LEA PHIL 30 Menox 18 Total fluoroscopy time (sec) 2460 (900–3761) Total injection time (sec) 55 (51–70) 325 (480–980) Time per single injection (sec) 5.8 (6.6–12.1) 21.1 (12–50.1) Injection pause time (sec) 0.4 (1.1–2.2) 1.1 (0.4–30) Injections (No.) 4.1 (2–5) 11 (8–35) Total volume of LEA per procedure (mL) 0.9 (0.7–2.3) 4.1 (1.2–6) ↵a Data are presented as median (lower quartile; upper quartile).
