Abstract

Endovascular embolization of cerebral arteriovenous malformations (AVMs) has become an acceptable treatment. One commonly used embolic agent is n-butyl 2-cyanoacrylate (NBCA). The key to curative embolization of an AVM is complete glue casting of the arteriovenous transition (nidus) that requires precise knowledge of NBCA polymerization dynamics and its interaction with the arterial wall. We have created a model of a human AVM [1] in the rete of swine to investigate NBCA behavior. Embolizations were performed in both in acutely prepared endovascular AVM models as well as in surgically prepared AVM models where the vasculature was allowed to adjust to altered hemodynamic conditions. 30 AVM models were created and five embolic agent compositions were used to embolize the retia, yielding six samples for each glue composition. The retia were harvested and high-resolution radiographic images were obtained. The images were analyzed for penetration depth of the various mixtures vis-a-vis the prevailing hemodynamic condition just prior to embolization. Image processing tools and mathematical modeling were applied to predict the behavior of NBCA polymerization.

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