Embolic materials cerebral arteriovenous malformations

Goto, K., Uda, K. Ogata, N. (1998) Embolization of cerebral arteriovenous malformations (AVMs) Material selection, improved technique, and tactics in the initial therapy of cerebral AVMs. Neurologia Medicu-Chirurgica Suppl, 38, 193-199. 

Abstract This chapter focuses on the vascular applications of injectable biomatetials. Two clinically relevant vascular conditions, cerebral arteriovenous malformations and intracranial aneurysm, will be discussed in terms of endovascular embolization. This chapter then outlines available embolic materials used to treat each condition, as well as highlighting new injectable biomaterials developed for embolization purposes. 

N-butyl cyanoacrylate (NBCA) is a liquid embolic material, in addition to being a tissue adhesive, that is approved by the USA FDA for use in embolization of cerebral arteriovenous malformations (AVM). It offers the advantages of low viscosity for easy injection through small catheters, but does not permeate all the way to the capillary level and thereby avoids tissue death. " ... 

Rare complications as have been reported in literature are aortic and bronchial necrosis [58], bronchial stenosis [59], unilateral diaphragmatic paralysis [60], pulmonary infarction (especially in patients who have suffered pulmonary artery embolism), left main bronchial-esophageal fistula [61], and non-target embolization (colon, coronary and cerebral circulation) [62]. Especially the newer spherical embolic materials (tris-acryl gelatin) can traverse from the bronchial into the pulmonary circulation, and then through unoccluded pulmonary arteriovenous malformations into the systemic circulation [41]. 

---