Arterial Route Research Articles

Radioprotection et voies d’abord en cardiologie interventionnelle

Since its introduction as a routine arterial route for interventional cardiology, the radial route has been associated with higher X-rays doses, either to the patient and the operator. There is less evidence for this association in recent studies, probably due to the learning curve for this approach, improvement in radiological equipments and in radiation protection techniques. Coronary angiography and percutaneous coronary interventions can be performed by radial route routinely with very low levels of exposure for the patient (<50% of the reference levels). However, for a fixed dose to patient, the operator's exposure remains higher by radial route, compared to femoral route. Optimized individual radiation protection devices for operators are mandatory when procedures are performed by radial approach.

Treatment of Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus

To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus. Review of prospectively collected data. Academic referral center. Fourteen patients with clinically and radiographically diagnosed DAVFs. Treated by endovascular route. Treatments, clinical course, complications, and evolution were evaluated. All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality. Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.

Inadvertent intraarterial injection of propofol in a patient under general anesthesia

injection of propofol under sedation or general anesthesia would be one of the important symptoms of intraarterial injection. In our case, the patient had an unpleasant sensation in the right metacarpophalangeal joints postoperatively. Propofol has been reported to produce vascular permeability change [3]. One case report mentioned that residual cutaneous hyperemia lasted for 12 days [4]. Furthermore, there is a possibility that intraarterial propofol attenuates capillary blood fl ow by particulate embolization or by physical interaction with blood components [5]. There may have been transient vascular hyperpermeability or a decrease in capillary blood fl ow in the present patient. Two laboratory studies [5,6] have shown that intraarterial propofol did not infl uence vasoactivity or vascular myogenic activity, and it was not toxic to the vessel wall. Intraarterial propofol has not been reported to cause irreversible sequelae, even when 8 ml of propofol was injected [1]. In contrast, the intraarterial injection of thiopental is known to cause endothelial cell destruction and necrosis, and urgent management of vasodilation or anticoagulation is required. Propofol may be a safer induction agent compared with thiopental. Nevertheless, it is important to prevent the intraarterial injection of propofol. After experiencing this incident, we have changed the color of the three-way stopcock to red, and the syringe has been connected to the three-way stopcock to avoid drug injection to the arterial route.

Endovascular Techniques for Treatment of Carotid-Cavernous Fistula

Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous communications in the cavernous sinus. Direct CCFs result from a tear in the intracavernous carotid artery. Indirect CCFs generally occur spontaneously and cause more subtle signs. Direct CCFs, which typically have high flow, usually present with ocular-orbital venous congestive features and cephalic bruit. Indirect CCFs, which typically have low flow, present with similar but more muted clinical features. Direct CCFs are always treated with endovascular methods. The goal is to occlude the fistula but preserve the patency of the internal carotid artery (ICA). Agents include detachable coils or liquid embolic agents delivered transarterially or transvenously. Arterial porous or covered stents are often used adjunctively. In rare cases, the ICA must be occluded. Indirect CCFs are only treated if symptoms are intractable or intolerable or if vision is threatened. The goal is to interrupt the fistulous communications and decrease the pressure in the cavernous sinus. The traditional approach has been transarterial embolization with liquid agents, particularly n-butyl cyanoacrylate (n-BCA). However, the multiplicity of arterial feeders and the low success rate in occluding indirect CCFs by the arterial route has led to a preference for transvenous embolization, most commonly via the inferior petrosal sinus. If that sinus is impassable, alternative routes include the pterygoid venous plexus, superior petrosal sinus, facial vein, or ophthalmic veins. The cavernous sinus is occluded with coils, liquid embolic agents, or both. The use of ethylene vinyl alcohol copolymer (Onyx), an agent that may be superior to n-BCA because it may allow better distal fistula penetration. However, more safety and efficacy data must be accumulated. When experienced interventionalists are involved, the success rate for closing direct fistulas is 85%-99% and for closing indirect fistulas is 70%-78%. Serious complications are relatively infrequent.

New Access for Radiofrequency Catheter Ablation of Left-Sided Atrioventricular Accessory Pathways Safety and Efficacy of the Transradial Approach

The safety and efficacy of the transradial approach for radiofrequency catheter ablation (RFCA) of left-sided atrioventricular accessory pathways (APs) was evaluated in the present study. Included were 40 consecutive patients with type A Wolff-Parkinson-White (WPW) syndrome who underwent RFCA via the radial artery route, and 30 patients with type A WPW syndrome who underwent RFCA via the transfemoral approach (controls) were retrospectively chosen for control. All 45 APs in the 40 patients were successfully ablated: 35 APs were successfully blocked with 1 ablation attempt, and the other 10 APs were ablated after 2-4 attempts. Compared with the transfemoral approach, the total procedure time for the transradial approach was longer (40 +/- 7.7 vs 32.4 +/- 8.7 min, P<0.05) and the fluoroscopic time was similar (7.2 +/- 2.2 vs 7.9 +/- 3.9 min, P>0.05). There were no vascular complications in the transradial group, but 2 patients in the transfemoral developed local hematoma. There was no recurrence of arrhythmia in either group. The transradial approach is a safe and effective access for RFCA of left-sided APs.

Mass balance, flow and subglacial processes of a modelled Younger Dryas ice cap in Scotland

AbstractWe use an empirically validated high-resolution three-dimensional ice-sheet model to investigate the mass-balance regime, flow mechanisms and subglacial characteristics of a simulated Younger Dryas Stadial ice cap in Scotland, and compare the resulting model forecasts with geological evidence. Input data for the model are basal topography, a temperature forcing derived from GRIP δ18O fluctuations and a precipitation distribution interpolated from modern data. The model employs a positive-degree-day scheme to calculate net mass balance within a domain of 112500 km2, which, under the imposed climate, gives rise to an elongate ice cap along the axis of the western Scottish Highlands. At its maximum, the ice cap is dynamically and thermally zoned, reflecting topographic and climatic controls, respectively. In order to link these palaeoglaciological conditions to geological interpretations, we calculate the relative balance between sliding and creep within the simulated ice cap, forecast areas of the ice cap with the greatest capacity for basal erosion and predict the likely pattern of subglacial drainage. We conclude that ice flow in central areas of the ice cap is largely due to internal deformation, and is associated with geological evidence of landscape preservation. Conversely, the distribution of streamlined landforms is linked to faster-flowing ice whose velocity is predominantly the result of basal sliding. The geometry of the main ice mass focuses subglacial erosion in the mid-sections of topographic troughs, and produces glaciohydraulic gradients that favour subglacial drainage through low-order arterial routes.

Abordaje orbitario para el tratamiento de la fístula carótido-cavernosa

A male patient with a left carotid-cavernous sinus fistula (CCSF) and two previous attempts of embolization via the femoral vein was treated with embolization through the superior ophthalmic vein (SOV). The main modality of treatment for CCSF is intervention radiology. This aims to occlude the fistula via an arterial route, through the cavernous sinus, or via a venous route, through the inferior petrosus sinus. However, the CCSF is also accessible through the SOV.

Lesion Complexity and Angiographic Outcomes in Radial Access Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) is increasingly performed from the radial arterial (RA) access site. Few studies have examined the interaction between a default radial approach, lesion complexity, and angiographic outcome. This study investigates lesion complexity, arterial access route, and angiographic outcome in routine clinical practice by default radial operators. All cases of PCI over a 12-month period (Jan 2005 to Jan 2006) at our regional cardiac center were prospectively entered into a database detailing arterial access route, target vessel and lesion characteristics, and lesion-specific angiographic outcome. Angiographic success was defined as residual stenosis <50% for balloon angioplasty alone or <20% for a stented lesion in the presence of TIMI 3 flow in the target vessel. All procedures carried out by default radial operators were selected for further retrospective analysis. Reasons for not completing a case via the radial route were recorded. Radial and femoral cases by default radial operators were evaluated on grounds of lesion complexity and angiographic outcome for each treated lesion. RA was the intended route in 91.5% of 1,324 procedures (91.5% of 2,239 lesions), and the final route in 90.1% of procedures (90.2% of lesions). There were 19 crossover procedures (30 lesions), all from radial to femoral access (FA). Crossovers were due to failed radial artery cannulation or sheath placement (9 procedures), inability to advance the guide catheter into the aortic root (7 procedures), and other guide catheter handling or support issues (3 procedures). Counting crossovers as failures, angiographic success rate was 96% among lesions for which RA was the primary intention. Complexity of cases was high (80.1% of RA lesions ACC/AHA type B2 or C). A default radial approach is compatible with successful treatment of a wide range of coronary lesions, with a low incidence of crossover to femoral access. When the radial approach fails, it is usually due to access problems rather than issues of guide catheter handling and support.

Intravascular Hemolytic Anemia with Acanthocytosis Following Alternative Treatment with Ozone, UV Light, and Perflurocarbon

Alternative medicine has become more common as patients seek approaches to diseases where traditional medicine has failed. Treatment with ozone has been purported to have benefits for a variety of infectious, inflammatory and neoplastic conditions. Treatment can be administered by the intra arterial, intravenous, intra rectal and subcutaneous routes as well as ozonated autohaemotherapy. We describe a 44 year old woman who received treatment at an alternative medical center for recurrent breast cancer including laetrile, perflurocarbon emulsion, high dose ascorbic acid, vitamin K and extracorporeal treatment of her blood with ozone and ultraviolet light. After receiving her second treatment, she presented to our hospital with a syncopal episode and was found to be anemic (Hb 4 gm/dl). The LDH was 8X> ULN, the serum haptoglobin was undetectable, and the reticulocyte count was increased. The peripheral blood smear showed aniscocytosis, poikilocytosis and polychromasia. There was also severe acanthocytosis. Heinz bodies were not detected. The patient refused blood products and after 48h of hospitalization, her Hb rose to 7gm and she was discharged. She did not return for follow-up evaluation.Acanthocytosis has been associated with impairment of cholesterol membrane fluidity seen with acquired hepatic disease as well as some congenital diseases. Oxidative stress can lead to peroxidation of membrane phospholipids, and if the intrinsic repair mechanism of the RBC is overwhelmed, the RBCs transform into acanthocytes. To date, there has been no literature describing hemolysis associated with any of the individual treatments which this patient received; however the combination of treatments exposed the RBC's to multiple oxidative stresses which might lead to lipid peroxidation and formation of acanthocytes. This case illustrates the potential problems that face clinicians when encountering patients who seek alternative therapy.

Proximity to Traffic, Inflammation, and Immune Function among Women in the Seattle, Washington, Area

BackgroundTraffic-related air pollution has been associated with adverse health outcomes, and the immune system may be a biologic mediator of health effects.ObjectivesWe analyzed associations between living near major roads and immune status as measured by five immune assays. We hypothesized that living near a freeway, arterial, or truck route would be associated with increased inflammation and decreased immune function.MethodsWe used a geographic information system (GIS) to determine residential proximity to major roads among 115 postmenopausal, overweight women in the greater Seattle, Washington (USA), area whose immunity was assessed at the baseline visit of an exercise intervention trial. We evaluated three inflammatory markers (C-reactive protein, serum amyloid A, and interleukin-6) and two functional assays of cellular immunity [natural killer (NK) cell cytotoxicity and T-lymphocyte proliferation].ResultsWomen living within 150 m of arterial roads had 21% lower NK cytotoxicity compared with women who lived farther from an arterial [mean cytotoxicity, 19.5%; 95% confidence interval (CI), 15.6–23.5%; vs. mean cytotoxicity, 24.8%; 95% CI, 22.0–27.5%], after adjustment for both individual-level and census tract–level demographic characteristics. This association was limited to women who reported exercising near traffic. Fewer women lived near freeways and truck routes. Markers of inflammation and lymphocyte proliferation did not consistently differ according to proximity to major roads.ConclusionsIf the observed association between residential proximity to traffic and decreased NK cytotoxicity is confirmed in other populations, our results may have implications for local land use policy.

Use of the femoral artery route for placement of temporary catheters for emergency haemodialysis when all usual central venous access sites are exhausted

Urgent dialysis via a temporary central line may be impossible when all central veins are obstructed. We report 10 patients (7 males and 3 females) over a 5-year period who lost all venous access sites, due to multiple peripheral venous thromboses with a superior vena cava obstruction or stenosis in 50%. These patients required urgent haemodialysis prior to general anaesthetic for a surgical intervention, but in all cases a traditional central venous line could not be used. They were therefore dialysed via a femoral artery catheter (FAC) before surgical rescue or creation of a more definite vascular access (VA). The median age of these patients was 64.7 years. None were suitable for peritoneal dialysis or urgent transplantation. Thirteen FACs (11F dual lumen dialysis catheter) were inserted into the common femoral artery. Both lumens were perfused continuously with heparinized saline (12 000 IU/24 h). All patients underwent a surgical procedure (rescue of previous access/creation of a new exotic one). First dialysis adequacy was assessed and compared to the rescued or new access. All patients had been on haemodialysis for a median period of 4.4 years. The mean number of previous access procedures was 17 (range 10-28). The duration of FAC use ranged from 1 to 12 days (mean 5 days). Dialysis adequacy was satisfactory for all patients. Seven patients had a complex vascular access formed and six had thrombectomy of their previous access. There were two complications related to FAC use, which were distal ischaemia and bleeding. Three patients died from access-related problems at 0, 4.6 and 15.0 months. Seven are still dialysed through their fistula or graft as outpatients with a mean follow-up of 14.0 months (range 0-50.9 months). Femoral artery dialysis is an effective means of haemodialysis as a method to bridge the gap before definitive vascular access formation when all other options have been exhausted.

Briefing: A30 environment work wins global award

Award-winning work on the A30 Bodmin to Indian Queens improvement scheme, Cornwall, UK, has reduced the environmental impact of the road that forms the key arterial route for the county of Cornwall.

Transition metals and water-soluble ions in deposits on a building and their potential catalysis of stone decay

Atmospheric particulates (dust) deposited on buildings are a complex chemical and mineralogical mixture including transition metal oxide matrices that act as a significant medium for further surface reactions and provide efficient sinks for pollutants, especially in urban environments. Once deposited, their transformation by reaction with specific and often highly localised environmental conditions across building facades is related to their degree of exposure to rain-wash. These transformations are central to the soiling of buildings and the availability of salts that lead to stone decay. To investigate these relationships, samples were collected at high and low elevations and under highly and moderately sheltered conditions from a building located on a busy arterial route in Budapest. Selective extraction analysis highlights the mobility/availability of Fe, Mn, Zn, Cu, Cr, Pb and Ni, plus water-soluble Ca 2+, Mg 2+, Na +, K +, Cl −, SO 4 2− and NO 3 − and their potential to take part in surface reactions that could enhance stone decay. Concentrations of water-soluble Fe, Mn and Zn in sheltered dust reach 126 mg kg −1, 80 mg kg −1 and 220 mg kg −1 respectively and under acidic environmental conditions and high humidity, similar levels of Mn and significantly higher concentrations of Fe, Zn, Cu and Pb may be released from the exchangeable/carbonate phase making these metals potentially available to catalyse surface reactions. Sulphate and nitrate coatings plus sufficient moisture increase metal solubility and active sites may be regenerated allowing mobile transition metals to become available and possibly catalyse further surface reactions.

Bullet Embolism after Gunshot Injury: A Case Report

We describe a case of gunshot injury presenting with cardiac tamponade in which a dummy bullet advanced through the aorta and caused embolization in the right renal interlobar artery after passing above the sternoclavicular joint and penetrating into the aorta. Emergency surgery with cardiopulmonary bypass was performed to repair the cardiac tamponade and aortic injury. Postoperatively, a direct abdominal x ray revealed a bullet image, confirmed by an ultrasonography examination that demonstrated the presence of a metal object in the right renal pelvis. The bullet was considered to have reached the kidney via an arterial route and to cause embolization in the distal bed. The procedure was successful, and the patient was discharged on postoperative day 8. In gunshot injuries, if all entrance points are not paired with exit points, the possibility of an organ or extremity embolism caused by the presence of a bullet or shrapnel fragments in circulation should be borne in mind, although such occurrences are rare.

The effects of route choice decisions on vehicle energy consumption and emissions

Motorists typically select routes that minimize their travel time or generalized cost. This may entail traveling on longer but faster routes. This raises questions concerning whether traveling along a longer but faster route results in energy and/or air quality improvements. We investigate the impacts of route choice decisions on vehicle energy consumption and emission rates for different vehicle types using microscopic and macroscopic emission estimation tools. The results demonstrate that the faster highway route choice is not always the best from an environmental and energy consumption perspective. Specifically, significant improvements to energy and air quality can be achieved when motorists utilize a slower arterial route although they incur additional travel time. The study also demonstrates that macroscopic emission estimation tools (e.g., MOBILE6) can produce erroneous conclusions given that they ignore transient vehicle behavior along a route. The findings suggest that an emission- and energy-optimized traffic assignment can significantly improve emissions over the standard user equilibrium and system optimum assignment formulations. Finally, the study demonstrates that a small portion of the entire trip involves high engine-load conditions that produce significant increases in emissions; demonstrating that by minimizing high-emitting driving behavior, air quality can be improved significantly.

Percutaneous mitral annuloplasty through the coronary sinus: An anatomic point of view

We assessed the anatomic relationships among the mitral annulus, coronary sinus, and circumflex artery in human cadaver hearts. Percutaneous posterior mitral annuloplasty has been proposed to treat functional mitral regurgitation on the basis of the proximity of the coronary sinus to the mitral annulus. However, concern remains about the ability to perform a trigone-to-trigone posterior annuloplasty and the potential for compromise of the circumflex coronary artery. Ten hearts were studied after injection of expansible foam into the coronary sinus and circumflex artery. The mitral annulus perimeter, posterior intertrigonal (T1-T2) and intercommissural (C1-C2) distance, and coronary sinus projection on the native annulus (S1-S2) were measured. The spatial geometry of the coronary sinus was correlated with the circumflex artery route and the distance with the native mitral annulus. The projection of coronary sinus annuloplasty achieves at best a commissure-to-commissure annuloplasty 14.5 (6-24) mm behind each trigone: T1-T2: 74 (56-114) mm, C1-C2: 62.2 (48-80) mm, S1-S2: 59.5 (40-80) mm. The coronary sinus was distant from the native annulus (8-14 mm at the coronary sinus ostium, 13.7-20.4 mm at the middle of the coronary sinus, 6.9-14 mm at the level of the great coronary vein). The circumflex artery was located between the coronary sinus and the mitral annulus in 45.5% of cases. This anatomic study highlights the 3-dimensional structure of the coronary sinus and its distance from the native mitral annulus and fibrous trigones. Human anatomic studies are mandatory for the further development of percutaneous mitral repair technology.

Models for Safety Analysis of Road Surface Transit

A study was done to explore the development of zonal- and arterial-level collision prediction models that incorporate characteristics applicable to urban transit planning. A generalized linear modeling approach with a negative binomial regression error structure was employed by using a data set from Toronto, Ontario, Canada. The zonal-level models indicate that vehicle kilometers traveled, bus or streetcar kilometers traveled, arterial road kilometers, bus stop density, percentage of near-sided stops, and average posted speed have significant associations with occurrences of transit-involved collisions. The arterial-level models, which were developed for collisions involving all motor vehicles, suggest that average annual daily traffic, transit frequency, segment length, presence of on-street parking, and percentage of near-sided stops are all associated with increased frequency of these collisions, whereas percentage of far-sided stops and average stop spacing are linked with reduced collision frequency. It is evident that models such as those developed in this study can provide transit agencies with decision-support tools for considering safety implications in the strategic and service-planning processes. These models can also be used as a tool to predict future levels of transit-involved collisions for an existing and a new transportation network or arterial route.

Stenting the ductus arteriosus: Case selection, technique and possible complications

Ductal stenting is an attractive alternative to conventional shunt surgery in duct dependent congenital heart disease as it avoids thoracotomy and its related problems. With today's generation of coronary stents which have better profile, flexibility and trackability, ductal stenting may be achieved safely and with considerably less difficulty than previously described.As in Blalock-Taussig (BT) shunt, ductal stenting is indicated mainly in duct-dependent cyanotic lesions chiefly in the neonatal period. Unlike the Patent ductus arteriosus (PDA) as an isolated lesion, the ductus in cyanotic heart disease has a remarkable morphologic variability. The ductus tends to arise more proximally under the aortic arch, giving rise to a vertical ductus or occasionally it may arise from the subclavian artery. It also tends to be long and sometimes very tortuous, rendering stent implantation technically impossible. The ductus in these patients may also insert onto one of the branch pulmonary arteries with some stenosis at the site of insertion. The ductus in Tetralogy of Fallot with pulmonary atresia (TOF-PA) tend to exhibit these morphologic features and to a lesser degree in transposition of great arteries with ventricular septal defect and pulmonary atresia (TGA-VSD-PA) and the more complex forms of univentricular hearts. In the preliminary angiographic evaluation, it is important to delineate these morphologic features as the basis for case selection.Ductal stenting may be done by the retrograde femoral artery route or the antegrade transvenous route depending on the ductus morphology and the underlying cardiac lesion. The detailed techniques and essential hardware are described. Finally, major potential complications of the procedure are described. Acute stent thrombosis is the most serious and potentially catastrophic. Emergent treatment with thrombolytic therapy and mechanical disruption of thrombus are required. With proper case selection, appropriate technique and the right hardware ductal stenting provides reasonable short-medium term palliation in duct-dependent cyanotic heart disease.

Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes

Although underestimated by interventional cardiologists for a long time, radiation exposure of operators and patients is currently a major concern. The objective of the present operator-blinded registry was to compare related-peripheral arterial route radiation exposure of operators. During 420 consecutive coronary angiograms (CAs) and percutaneous coronary interventions (PCIs), four interventional cardiologists were blindly screened. Radiation exposures were assessed using electronic personal dosimeters. Protection of operator was ensured using a lead apron, low leaded flaps, and leaded glass. Radiation exposure of operators was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs: 29.0 [1.0-195.0] microSv vs. 13.0 [1.0-164.0] microSv; P < 0.0001 and 69.5 [4.0-531.0] microSv vs. 41.0 [2.0-360.0] microSv; P = 0.018, respectively. Similarly, radiation exposure of patients was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs. Moreover, procedural durations and fluoroscopy times were significantly higher throughout the radial route. Although the radial route decreases peripheral arterial complication rates, increased radiation exposure of operators despite extensive use of specific protection devices is currently a growing problem for the interventional cardiologist health. Radial route indication should be promptly reconsidered in the light of the present findings.

Preoperative embolization of hypervascular head and neck tumours

The embolization of vascular tumours of the head and neck has become an important adjunct to the surgical treatment of these tumours. A vascular tumour in the head and neck region in a surgically treatable patient may be a candidate for embolization. Palliative embolization may be the sole treatment for high risk patients. Reducing intraoperative bleeding may shorten surgery time thus decreasing morbidity and mortality. The purpose of this study is to assess the efficacy of embolization as an adjunct to surgery or as a curative measure in the management of hypervascular head and neck tumours. We retrospectively reviewed the records of 46 consecutive patients (27 men and 16 women; mean age, 37.8 years) with 48 hypervascular head and neck tumours that had undergone preoperative transarterial, direct puncture or combined mode of embolization. Diagnosis of tumours was made on the basis of findings of imaging studies. The 46 patients underwent embolization either through transarterial route, by direct puncture technique or both direct puncture and arterial route. The devascularization reached 90-95% with the use of NBCA. The amount of devascularization reached by transarterial particle embolization is a little lesser. One patient (carotid body tumour) developed mild unilateral seventh, ninth and 10th cranial nerve palsy after transarterial embolization, transient hemiparesis was seen in another patient (nasopharyngeal angiofibroma). Both patients improved completely with steroids and had no deficit on follow up. One patient developed delayed glue migration into the middle cerebral artery territory 6 h after the procedure with no reported increase in size of the lesion in the following 5 years. Preoperative embolization of hypervascular tumour of head and neck region appears to be safe and improves the chance of complete removal during surgery with minimal blood loss.