Abstract
BackgroundNon-target embolization is a well-known complication of endovascular procedures for arteriovenous malformation. However, few reports have described non target encephalic embolization, detailing its temporal evolution.Case presentationA 41-year-old man presented with a massive hemorrhage in the oral cavity due to an arteriovenous malformation involving the left hemiface and tongue. Under conscious sedation, selective angiography was followed by endovascular embolization with a mixture of n-butyl-cyanoacrylate-methacryloxy-sulfolane (NBCA-MS) with Lipiodol. The hemorrhage was successfully arrested, but the procedure was complicated with a reflux of embolic material from the right external carotid artery into the common carotid, caused by strong unexpected coughing. Non-target embolization was confirmed by emergency CT and subsequent MRI. After initial neurological impairment, the patient recovered fully and was discharged after one week. No sequelae were confirmed by 9-months follow-up with CT and MRI. We describe technical aspects, multimodality imaging, clinical presentation, and follow-up of this peculiar case.ConclusionEndovascular embolization of AVM fed by the external carotid is at risk for non-target brain embolization and general anesthesia should be considered to prevent inadvertent movements and master the delivery of the embolic agent A small amount of Lipiodol / NBCA-MS may be fully tolerated by the brain matter and partially reabsorbed without permanent deficit.
Highlights
Endovascular embolization of Arteriovenous malformation (AVM) fed by the external carotid is at risk for non-target brain embolization and general anesthesia should be considered to prevent inadvertent movements and master the delivery of the embolic agent A small amount of Lipiodol / NBCA-MS may be fully tolerated by the brain matter and partially reabsorbed without permanent deficit
Arteriovenous malformations (AVMs) are low-resistance vascular congenital abnormalities made of dysplastic arteries and veins arranged in a primitive reticular network
We describe the event of non-target embolization of n-butyl-cyanoacrylate-methacryloxy-sulfolane (NBCA-MS) in the brain occurred during endovascular treatment of a facial AVM
Summary
Embolization of AVMs with nidal arteries arising from the external carotid artery is at risk for non-target brain embolization. Patients’ immobility is desirable and deep anesthesia should be discussed with the anesthesiologist to prevent the coughing reflex, which can temporarily reverse blood flow and cause reflux. In this single case a small embolus of 1:5 mixture of NBCAMS/Lipiodol was fully tolerated by the brain matter, leaving no permanent damage as confirmed after a follow-up of nine months
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
