title: Embolization of cerebral arteriovenous malformations with silk: histopathologic changes and hemorrhagic complications.
abstract: OBJECTIVE
  To evaluate the safety of silk as an embolic agent for preoperative embolization of cerebral arteriovenous malformations (AVMs) by assessing the histopathologic changes and hemorrhagic complications associated with its use.
  
  
  METHODS
  Histopathologic specimens, medical records, and radiologic records of 73 patients with AVMs embolized with silk (alone or in combination with other agents) were reviewed retrospectively. Forty-eight histologic specimens obtained at surgery were analyzed for inflammatory responses and compared with the time interval between embolization and surgery. Postembolization angiograms were assessed for vasculitis and CT scans were reviewed for evidence of hemorrhage after embolization.
  
  
  RESULTS
  There was no angiographic evidence of vasculitis. Histologic evidence of vasculitis was absent or mild in 92% of cases and histologic evidence of perivascular inflammation was absent or mild in 73% of cases. The frequency of histologic changes associated with vasculitis, perivascular inflammation, and vessel necrosis varied with the time interval between embolization and AVM resection. Intracranial hemorrhage, as a direct complication of silk use, occurred in one patient. Another patient had subarachnoid hemorrhage 24 hours after embolization, caused by rupture of a posteroinferior cerebellar artery aneurysm. Intraventricular high-density material appeared on routine postembolization CT scans in two other patients who had intraventricular AVM extension. This high-density material was thought to be contrast extravasation from intrinsically leaky AVM nidus vessels and not frank hemorrhage.
  
  
  CONCLUSIONS
  Embolization of AVMs with silk does not result in marked inflammation or increased hemorrhagic complications as compared with other agents.
authors.affiliation: Department of Radiology, University of Washington, Seattle 98195, USA.
authors.forename: F
authors.initials: F
authors.lastname: Schmutz
authors.forename: W
authors.initials: W
authors.lastname: McAuliffe
authors.forename: D M
authors.initials: DM
authors.lastname: Anderson
authors.forename: J P
authors.initials: JP
authors.lastname: Elliott
authors.forename: J M
authors.initials: JM
authors.lastname: Eskridge
authors.forename: H R
authors.initials: HR
authors.lastname: Winn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000473:pathology* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000473:pathology; D005260:Female; D005549:Foreign-Body Reaction / Q000473:pathology; D006801:Humans; D019476:Insect Proteins / Q000009:adverse effects; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D047011:Silk; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D019476:Insect Proteins; D047011:Silk