Dae Chul Suh1, Su Hee Cho2, Ji Eun Park2, Hairi Liu3, Sung Chul Jung2. 1. Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea. Electronic address: dcsuh@amc.seoul.kr. 2. Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea. 3. Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China.
Abstract
OBJECTIVE: To promote embolization of spinal dural arteriovenous fistula (SDAVF) with a small long tortuous feeder that may impede successful application of an embolic agent. METHODS: An induced-wedge technique was developed in which blood flow was blocked by coiling at the proximal part of the microcatheter for secure injection of N-butyl cyanoacrylate. We used this technique in 11 patients with SDAVF (male/female ratio, 8:3): 7 thoracic, 2 lumbar, 1 sacral, and 1 cervical. Clinical outcome was evaluated by the Aminoff-Logue Disability Scale. RESULTS: Penetration of embolic agent through the fistula into the vein was complete (n = 5), nearly complete (no penetration of embolic agent into the vein but no residual fistula on 3 adjacent selective angiograms; n = 4), or partial (embolization with a small residual filling of the draining vein; n = 2). All patients improved neurologically during follow-up (median, 18 months; range, 7-37 months) and achieved complete recovery. Of the 2 patients who obtained partial obliteration, one showed disappearance of the residual lesion on angiography 21 months later and the other achieved complete results after repeat embolization. CONCLUSIONS: The induced-wedge technique can improve SDAVF embolization by providing better penetration of the liquid embolic agent to the fistula and vein. Copyright Â
OBJECTIVE: To promote embolization of spinal dural arteriovenous fistula (SDAVF) with a small long tortuous feeder that may impede successful application of an embolic agent. METHODS: An induced-wedge technique was developed in which blood flow was blocked by coiling at the proximal part of the microcatheter for secure injection of N-butyl cyanoacrylate. We used this technique in 11 patients with SDAVF (male/female ratio, 8:3): 7 thoracic, 2 lumbar, 1 sacral, and 1 cervical. Clinical outcome was evaluated by the Aminoff-Logue Disability Scale. RESULTS: Penetration of embolic agent through the fistula into the vein was complete (n = 5), nearly complete (no penetration of embolic agent into the vein but no residual fistula on 3 adjacent selective angiograms; n = 4), or partial (embolization with a small residual filling of the draining vein; n = 2). All patients improved neurologically during follow-up (median, 18 months; range, 7-37 months) and achieved complete recovery. Of the 2 patients who obtained partial obliteration, one showed disappearance of the residual lesion on angiography 21 months later and the other achieved complete results after repeat embolization. CONCLUSIONS: The induced-wedge technique can improve SDAVF embolization by providing better penetration of the liquid embolic agent to the fistula and vein. Copyright Â
Authors: Dae Chul Suh; Soo Jeong; Yun Hyeok Choi; Su Min Cho; Su Young Yun; A Yeun Son; Young Min Lim; Boseong Kwon; Yunsun Song Journal: Neurointervention Date: 2022-06-15
Authors: Keun Young Park; Jin Woo Kim; Byung Moon Kim; Dong Joon Kim; Joonho Chung; Chang Ki Jang; Jun Hwee Kim Journal: Korean J Radiol Date: 2019-08 Impact factor: 3.500