Adenosine induced cardiac pause in neuroendovascular management of AVM with fistula

Abstract

Embolization as the sole therapeutic option to completely obliterate an AVM as reported varies between 5% and 53.9% (Bruno et al., 2013). Smaller AVM’s and those with single or few feeders can be cured completely with embolization alone, using either glue or EVOH formulations. Some AVM’s may harbor intranidal fistulae and these AVM’s are at increased risk for bleeding and should be treated by embolization before excision or radiosurgery. Glue embolization in a high flow situation carries the hazard of distal migration. We present a less frequently used approach to achieve total obliteration of an AVM with intranidal fistulas using cyanoacrylate glue and a single micro catheter with pharmacologically induced circulatory arrest. The use of adenosine is relatively inexpensive and adds economic advantage to the procedure. In carefully planned and selected cases using a single micro catheter glue can be deposited with minimal venous rundown to completely obliterate the AVM without the need for coils and other devices. Keywords: AVM with microfistula, Pharmacological flow arrest, Technical note, Embolisation of AVM