Embolization of cerebral arteriovenous malformations with cellulose acetate polymer: a clinical, radiological, and histological study.
OBJECTIVE
A cellulose acetate polymer (CAP) solution was hypothesized to be useful for the embolization of arteriovenous malformations (AVMs). To investigate this possibility, we analyzed the clinical, radiological, and histological results of patients with AVMs embolized by using a CAP solution.


METHODS
We reviewed the cases of 11 patients with AVMs treated by embolization before surgical resection. We used two types of CAP solutions, CAP-M and CAP-L, which are mixtures of 250 mg of solid CAP and 1800 or 2250 mg of bismuth trioxide dissolved in 5.5 or 7.0 ml of dimethyl sulfoxide, respectively. After the embolization procedure, percent reduction of the nidus volume was measured, and thereafter, the clinical course and computed tomographic scans and/or magnetic resonance imaging scans were evaluated. All patients underwent surgical resection 1 to 51 days after embolization. Resected specimens were stained for light microscopic examination.


RESULTS
Thirty-nine feeding vessels were embolized. The reduction rate of the nidus volume ranged from 20% to nearly 100%. Transient and persistent ischemic deficits occurred in three patients and one patient, respectively, and there were no hemorrhagic complications. All AVMs but one were completely resected by surgery. The embolized AVMs were soft enough to be easily cut and retracted. The histological examinations disclosed no or mild inflammatory reactions within 2 weeks after embolization. The internal elastic lamina was preserved in every case. Recanalization through the cast of the CAP mass was not observed until 51 days after embolization.


CONCLUSIONS
CAP solution is a safe and useful embolic agent for AVMs.
Tokunaga
K
K
Department of Neurological Surgery, Okayama University Medical School, Japan.
Kinugasa
K
K
Kawada
S
S
Nakashima
H
H
Tamiya
T
T
Hirotsune
N
N
Mandai
S
S
Ohmoto
T
T
D000328:Adult; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002482:Cellulose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002533:Cerebral Angiography; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000627:therapeutic use*
D001672:Biocompatible Materials; D011108:Polymers; C005062:acetylcellulose; D002482:Cellulose