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HISTORY: Left temporo-parietal arteriovenous malformation
PROPOSED THERAPY: Staged endovascular treatment of the AVM
PROCEDURE:
- Selective catheterization of the left internal carotid artery for
diagnostic evaluation. The angiogram demonstrated a large AVM with
multiple feeders from the left MCA branches and the left anterior
choroidal artery. The AVM drained primarily into Sylvian veins, ultimately
reaching the vein of Labbe. There were also smaller deep veins draining
into the vein of Rosenthal.
- A 6F Envoy guide catheter was placed into the cervical carotid artery
at C1/C2 vertebral level.
- A Synchro Neuro Guide Wire was used to deliver a Cordis Prowler
14 microcatheter into branch #1 of the anterior temporal branch of
the left MCA.
- After positioning the tip of the microcatheter close to the nidus,
this vessel was embolized with a 70:30 v/v ratio of Ethiodol:n-BCA.
Complete intranidal glue cast was achieved.
- Using the same Synchro Guide Wire, a new microcatheter was introduced
into branch #2 of the temporal branch of the left MCA. This branch
was also successfully obliterated with an intranidal cast of the same
mixture of n-BCA.
- The same Synchro Guide Wire was again used to deliver another Prowler
14 microcatheter to the frontal branch of the left MCA, and the vessel
was completely occluded with intranidal glue cast using the same mixture
of n-BCA.
- Final post-embolization angiography confirmed complete occlusion
of all three branches with an excellent intranidal glue cast, and
a 20% reduction in the size of the AVM nidus.
- In the same embolization session, previous attempts of using current
standard 0.014" guide wires such as the Transend or Agility to navigate
the Prowler 14 had failed. This test was performed in the same vasculature
of the MCA system.
OBSERVATIONS: A single Precision Vascular Synchro Neuro Guide Wire
was used to place all three microcatheters. The ability to use only one
Synchro guide wire in place of several conventional guide wires demonstrates
the cost-effectiveness of this new device.
PRODUCTS USED:
Precision Vascular 0.014" Synchro™ Guide Wire
Cordis Prowler® 14 Microcatheter
Cordis TRUFILL®n-BCA
Boston Scientific/Target Transend® 0.014" Guide Wire
Cordis Agility™ 0.014" Guide Wire
WLT0102/A
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