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Endovascular Treatment of Arteriovenous Malformations Using Ethylene Vinyl Alcohol Copolymer

  • Bruno C. Flores
  • Bradley A. Gross
  • Felipe C. Albuquerque
Chapter

Abstract

Over the past two decades, endovascular embolization has become a fundamental part of a multidisciplinary approach for the treatment of intracranial arteriovenous malformations (AVMs). Several embolic agents are now an intrinsic part of the neurointerventional armamentarium. However, none has represented as remarkable an improvement as the introduction of ethylene vinyl alcohol copolymer (EVOH). In conjunction with n-butyl cyanoacrylate (NBCA), EVOH has revolutionized the endovascular management of intracranial AVMs because of its ability to systematically deliver a sufficient volume of the embolic agent to the nidus and pedicles without extension into the venous drainage. The clinical decision to treat an AVM is facilitated by preoperative risk stratification; the first question to be addressed is whether to treat the AVM; and, if so, the second question is how to treat it. Endovascular EVOH embolization is primarily applied as an adjunct treatment to microsurgical resection or radiosurgery. Few cases are amenable to angiographic cure by embolization alone. The goal of this chapter is to describe the pertinent properties, endovascular techniques, and pitfalls for the endovascular management of intracranial AVMs using EVOH.

Keywords

Arteriovenous malformations Embolization Ethylene vinyl alcohol copolymer Onyx 

Abbreviations

ACA

Anterior cerebral artery

AVM

Arteriovenous malformation

CE

Conformité Européenne

DMSO

Dimethyl sulfoxide

EVOH

Ethylene vinyl alcohol copolymer

FDA

US Food and Drug Administration

LES

Liquid embolic system

MCA

Middle cerebral artery

NBCA

n-butyl cyanoacrylate

PCA

Posterior cerebral artery

Notes

Acknowledgments

The authors thank the editorial staff of the Neuroscience Publications office of Barrow Neurological Institute for their invaluable assistance with the production of this chapter, without whom this work would not have been possible.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Bruno C. Flores
    • 1
  • Bradley A. Gross
    • 1
  • Felipe C. Albuquerque
    • 2
  1. 1.Department of NeurosurgeryBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA
  2. 2.c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA

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