Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization: initial success and rate of permanent cure.
OBJECTIVE
Endovascular treatment with cyanoacrylate embolization is an option when complete obliteration of the nidus of an intracranial arteriovenous malformation (AVM) is the goal. Our purpose was to evaluate the rates of initial success and permanent cure of such treatment in a Chinese population.


METHODS
Twenty-seven consecutive patients with an intracranial AVM underwent endovascular embolization with cyanoacrylate between June 1995 and May 1997. Twenty-six patients had cerebral AVMs and one had a cerebellar AVM. Curative embolization was attempted in 10 patients in whom 1) the nidus was not larger than 3 cm, 2) the number of feeders did not exceed three, and 3) the nidus was accessible with the tip of the catheter. We used a flow-directed microcatheter and a 20-25% mixture of cyanoacrylate in contrast medium. Long-term outcomes were observed angiographically and clinically.


RESULTS
Complete embolization was achieved in six patients. No procedure-related complications occurred during attempted curative embolization. Follow-up angiography performed at 17-32 months showed complete obliteration of the AVM nidus in the six patients after initial embolization. These patients remained asymptomatic 5-7 years after treatment. The rate of permanent cure of the initially complete embolization was 100% (six of six). The success rate of endovascular cure for patients treated with curative intent was 60% (six of 10). The overall cure rate was 22% (six of 27).


CONCLUSIONS
The overall initial cure rate of intracranial AVM with cyanoacrylate embolization was 22%. Initial angiographic evidence of complete embolization indicated permanent cure in these patients.
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, the Chinese University of Hong Kong, China.
Simon C H
SC
Yu
Michael S Y
MS
Chan
Joseph M K
JM
Lam
Patrick H T
PH
Tam
Wai S
WS
Poon
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000098:blood supply; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012086:Reoperation; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014014:Tissue Adhesives; D004659:Enbucrilate