title: Improved distal distribution of n-butyl cyanoacrylate glue by simultaneous injection of dextrose 5% through the guiding catheter: technical note.
abstract: BACKGROUND
  The use of n-butyl cyanoacrylate (NBCA) as an adhesive agent for embolization of high-flow intracranial and extracranial vascular lesions is well established. To be successful, the embolization of arteriovenous malformations and fistulas must achieve obliteration of the arteriovenous shunts themselves rather than simply occlude the feeders proximal to the lesion. However, the feeders cannot always be negotiated over their entire length. This is often the case with dural arteriovenous fistulas (DAVF), which are usually vascularized by long and intricate meningeal networks. In such situations, NBCA may not be able to reach the lesion itself, rendering the embolization ineffective. We present a new technique that improves distal distribution of NBCA glue.
  
  
  METHODS
  The technique described in this report consists of injecting dextrose 5% through the guiding catheter simultaneously with the superselective injection of NBCA glue into the targeted feeding branch. The technique is illustrated with three cases of posterior fossa DAVF.
  
  
  RESULTS
  In the reported cases, flooding the territory of the targeted vessel with non-ionic dextrose 5% allowed deep progression of the glue by delaying contact with ionic substances. Excellent distribution of the NBCA glue reaching the site of the arteriovenous shunts was thus obtained despite suboptimal proximal microcatheter tip positions.
  
  
  CONCLUSIONS
  Simultaneous perfusion of dextrose 5% through the guiding catheter during NBCA injection dramatically improves the distal progression of glue through small, tortuous arterial feeders. This technique has the potential to increase the therapeutic value of transarterial embolization for DAVFs.
authors.affiliation: Division of Interventional Neuroradiology, Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. phg@jhmi.edu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Moore
authors.forename: Kieran
authors.initials: K
authors.lastname: Murphy
authors.forename: Philippe
authors.initials: P
authors.lastname: Gailloud
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
chemical_list: D003487:Cyanoacrylates; D004659:Enbucrilate; D005947:Glucose