title: Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence and clinical significance of complications related to preoperative embolization of cerebral arteriovenous malformations (AVMs) with silk sutures as documented on postprocedure computerized tomography (CT) scans.
  
  
  METHODS
  The CT scans were obtained within 12 to 24 hours after 221 (96%) of 230 consecutive embolizations in 70 patients. These CT scans were evaluated for the presence of ischemia, infarction, hemorrhage, or contrast agent extravasation. Adverse patient outcomes were determined after each embolization and were correlated with CT findings. New abnormalities demonstrated on CT scans were also correlated with the Spetzler-Martin AVM grade, degree of arteriovenous shunting, and location. New abnormalities, the majority of them infarcts, resulted from 29 (13%) of 221 embolization procedures. In 11 (38%) of 29 cases of new CT findings, patients were asymptomatic, including 10 with new infarcts on CT scans. New neurological deficits occurred in 20 (8.7%) of 230 total embolization procedures in 19 patients, including one death. Permanent deficits occurred in nine patients (3.9% per embolization procedure, 12.8% per patient). Of the patients with new neurological deficits, 18 (90%) of 20 embolization procedures resulted in new abnormalities on CT scans. Two patients with new transient neurological deficits had no new findings on CT scans. Spetzler-Martin grade, AVM location, degree of arteriovenous shunting, and higher numbers of procedures were not statistically associated with a higher incidence of abnormalities on CT scans or new permanent neurological deficits.
  
  
  CONCLUSIONS
  Silk sutures are an effective and relatively safe embolic agent. After brain AVM embolization with silk sutures, new abnormalities were found on CT scans obtained in one of eight procedures. When a new CT finding occurred, the patient had roughly equal chances of having no new symptoms, having new transient neurological deficits, or having new permanent neurological deficits.
authors.affiliation: Department of Radiology, University of Washington, Seattle 98195, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: J M
authors.initials: JM
authors.lastname: Eskridge
authors.forename: E C
authors.initials: EC
authors.lastname: Chung
authors.forename: L C
authors.initials: LC
authors.lastname: Blake
authors.forename: J P
authors.initials: JP
authors.lastname: Elliott
authors.forename: L
authors.initials: L
authors.lastname: Finch
authors.forename: C
authors.initials: C
authors.lastname: Niakan
authors.forename: K R
authors.initials: KR
authors.lastname: Maravilla
authors.forename: H R
authors.initials: HR
authors.lastname: Winn
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D019476:Insect Proteins / Q000009:adverse effects; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D047011:Silk; D013537:Sutures / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D019476:Insect Proteins; D047011:Silk