Significance of feeder-based evaluation of brain arteriovenous malformations

Abstract

Background: Functional evaluation of the feeder vessels of the arteriovenous malformations (AVMs) through the super-selective cerebral angiography route reveals which tolerable and intolerable arteries are safe for embolization. Propofol is another agent, in place of amobarbital, for the provocative test. The purpose of this study was to show our experience using high doses of propofol as a reliable and effective drug in the neuroendovascular treatment of AVMs.

Patients and Methods: A series of 23 patients with 54 feeder arteries were embolized using neuroendovascular techniques. All patients were embolized under general anesthesia. Preembolization neurological examination was performed following a 20 mg dose of propofol injected through an intra-arterial route following microcatheter placement, in or near the AVM nidus.

Results: Among these 54 arteries, 4 vessels developed temporary neurological deficits after propofol injection, which were not occluded. None of the feeder arteries passing the provocative test showed a false tolerable result after embolization.

Conclusions: Embolization of cerebral AVMs by means of a feeder provocative test with high-dose propofol has yielded reliable results in this series, in which the feeder artery tolerability allows an increase in the safety of the procedure and reduces complications.