Abstract
Endovascular closure of high-flow arteriovenous (AV) shunts in intracranial AV malformations (AVMs) is technically challenging. When using liquid embolic agents, the high flow through the shunt may cause migration of the embolic agent to the venous outflow tract, with potentially devastating consequences. ED coils (Kaneka Medix Co., Osaka, Japan) are useful for preoperative embolization of high-flow feeders of AVMs via transarterial routes before n-butyl cyanoacrylate (NBCA) injection. Detachable coils may be inserted at the fistula site to decrease flow and may provide an anchoring point for NBCA injection. ED coils are compatible with the one-marker MarathonTM Flow Directed Micro Catheter (Irvine CA, Covidien) given that the detachment point between the coil and delivery wire is detected electrically and the delivery wire tip is flexible enough to navigate coils through long tortuous vessels. Here, we report the role of endovascular treatment with ED coils in the management of intra-cranial high flow AVMs.
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