title: [Endovascular treatment of intracranial arteriovenous malformation with n-butyl cyanoacrylate. Working methods and experience in 58 cases].
abstract: OBJECTIVE
  Arteriovenous malformations (AVMs) constitute malformative lesions of the central nervous system vasculature and cause significant morbidity and mortality. Endovascular embolization with n-butyl cyanoacrylate is a well established modality of AVM treatment, usually combined with surgery or radiosurgery. The purpose of this study was to characterise the AVMs that were treated endovascularly with n-butyl cyanoacrylate and to evaluate the post-embolization results in the Cuban population.
  
  
  METHODS
  From February 2006 to February 2011, a group of 58 consecutive patients with brain AVMs were embolized using n-butyl cyanoacrylate in the endovascular therapy unit of the Medical Surgical Research Centre in Havana (Cuba). In all, 91sessions were carried out with intranidal embolization and mainly partial devascularization, 25-30% per session, and closing 123 arterial pedicles. Safety times for n-butyl cyanoacrylate injection were established by calculating the polymerisation times for different dilutions, using post-embolisation hypotension systematically, as well as a superselective test with propofol to determine cerebral eloquence.
  
  
  RESULTS
  Haemorrhagic signs were the initial presentation in 68.8% of the patients, 24.1% presented with epileptic episodes and 1.7% with ischemic stroke. Of the AVMs, 93.2% were supratentorial; according to the Spetzler and Martin classification, 13.8% were grade II, 56.9% were grade III, 22.4% were grade IV and 6.8%, grade V. One hundred and twenty-eight selective tests with propofol were performed and 118 (92.2%) of those were negative. Partial devascularization (20-30%) prevailed; complete obliteration was achieved in 17.2% of the patients and 70%-99% in 27.5% of the patients. Safety times for n-butyl cyanoacrylate injection were established and the use of post-procedure hypotension was settled. Morbidity of 17.2%, with 6.9% haemorrhagic complications and mortality of 3.4% were registered in the whole series.
  
  
  CONCLUSIONS
  The rates of total occlusion and of morbidity and mortality in the series are in the internationally described ranges. The implementation of intranidal closings with 20-30% devascularization per session and the use of post-embolization hypotension after the haemorrhage complications described resulted in the total absence of haemorrhagic complications.
authors.affiliation: Departamento de Imaginología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Universidad Médica de La Habana, La Habana, Cuba; Unidad de Neurorradiología Intervencionista, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Universidad Médica de La Habana, La Habana, Cuba. Electronic address: jjordan@infomed.sld.cu.
authors.forename: José A
authors.initials: JA
authors.lastname: Jordan González
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Llibre Guerra
authors.forename: José A
authors.initials: JA
authors.lastname: Prince López
authors.forename: Frank
authors.initials: F
authors.lastname: Vázquez Luna
authors.forename: Raúl Marino
authors.initials: RM
authors.lastname: Rodríguez Ramos
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Ugarte Suarez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D002533:Cerebral Angiography; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D057510:Endovascular Procedures; D004827:Epilepsy / Q000209:etiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000209:etiology; D019585:Intracranial Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015742:Propofol; D014014:Tissue Adhesives / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate; D015742:Propofol