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Several months before the current case, the patient, a 65-year-old male was found unconscious with a large temporal hemorrhage. Hematoma evacuation and decompressive craniectomy was successfully performed; a small AVM is discovered in the medial part of the temporal lobe, but no embolization is attempted at this stage. Clinically controlled with hemiparesis and aphasia, the patient is discharged from the hospital at 33 days with mRS 3.
At 6-month follow-up, the patient shows total recovery of the right hemiparesis with minor aphasia, right hemianopsia and is able to walk alone with an mRS 2. Join Prof. Laurent Spelle as he employs a double venous and arterial approach to occlude the AVM using embolic material in this case presented live during LINNC Paris 2019 . With running commentary by Prof. Jacques Moret and the international LINNC expert panel, questions such as the importance of allowing for natural recovery, the ideal timing for treatment, reproducibility, stratification of risk and choosing between radiosurgery or an endovascular approach are discussed. A complex case due to the anatomy involved, watch as the treatment unfolds from imaging to the determination of the “segment of security”, the short nidus, the challenge of having no option for reflux as well as tips and tricks for the choice of material and their use. As the case proceeds see how, according to the flow and the structure of the AVM, that the viscosity of the embolic agent is adjusted and discover why the specific attributes of MicroVention’s PHILtm embolic agent – after initially appearing to rupture the nidus and flow into the subarachnoid space – allowed for an additional 10 minutes of ejection and completion of the intervention due to its use of iodine as a radiopaque material with less risk of occluding the catheter than other types of embolic agents.
With the AVM occluded in the final angiogram, and follow-up scheduled for the future – remember, it’s not because you prepare two approaches that you’ll use both!
This LIVE case corresponds to the highest ethical standards in medicine and is posted on LINNC Online for educational purposes only to allow medical professionals to improve their knowledge about these procedures and how to best treat their patients.