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Purpose: To evaluate the effectiveness and safety of transarterial glue embolization of intracranial dural arteriovenous shunts (DAVS)., Materials and Methods: Institutional review board approval was obtained, with waiver of informed consent, for this retrospective study. From a single-center database of information on 371 intracranial DAVS, data in 115 consecutive patients treated with transarterial glue embolization were identified and assessed. Clinical and angiographic features, including cure rate, complications, and outcome, were evaluated. The treatment results were also compared between the patients in the first half of the consecutive series and those in the second half. The mean glue concentrations used were compared between the first and second halves of the patient series by using the Student t test., Results: One hundred twenty-one lesions were treated with transarterial glue embolization. There were 31 (25.6%) Borden type I lesions, 39 (32.2%) Borden type II lesions, and 51 (42.1%) Borden type III lesions. Angiographic cure with glue embolization was achieved for 36 lesions (29.8%); 17 (14.0%) lesions were cured immediately, and 19 (15.7%) showed progressive thrombosis at follow-up. The angiographic cure rate for Borden type III lesions improved from 10% to 55% in the later group of patients as compared with the earlier group. The mean concentration of glue was significantly lower in the later group of patients. One (0.9%) of the 115 patients suffered permanent morbidity from aggravation of left extremity weakness due to venous thrombosis. Eight patients experienced nonpermanent morbidities, including transient worsening of neurologic status due to venous thrombosis (n = 4), alopecia (n = 2), scalp ulcer (n = 1), and pulmonary embolism (n = 1). Overall, improvement (n = 65) or stabilization (n = 32) of symptoms was seen in 84.3% of the patients., Conclusion: Transarterial glue embolization is a safe and effective method of primary treatment for intracranial DAVS, especially Borden type III lesions. Improvement of cure rates in the latter half of this study suggest that technical advances and experience may enhance outcomes., (© RSNA, 2010.)

Purpose: To prospectively identify risk factors for neurologic complications related to cerebral angiography., Materials and Methods: A total of 2,899 consecutive cerebral digital subtraction angiograms obtained with nonionic contrast material were prospectively evaluated. Neurologic complications were categorized as transient (<24 hours), reversible (24 hours to 7 days), and permanent (>7 days). The neurologic complication rate was correlated with patient age, type of indication for catheter angiography, medical history, fluoroscopic time, number and size of catheters, type and number of vessels injected, operator experience, and the quartile in which the study was performed. The correlations were statistically analyzed with Fisher exact tests and a multiple logistic regression model., Results: There were 39 (1.3%) neurologic complications in 2,899 procedures; 20 were transient (0.7%), five (0.2%) were reversible, and 14 (0.5%) were permanent. Neurologic complications were significantly more common in patients 55 years of age or older (25 of 1,361; 1.8%) (P =.035), in patients with cardiovascular disease (CVD) (20 of 862; 2.3%) (P =.004), and when fluoroscopic times were 10 minutes or longer (24 of 1,238; 1.9%) (P =.022). The neurologic complication rate was higher in procedures performed by fellows alone (24 of 1,878; 1.3%) compared with that when staff alone performed the procedures (three of 598; 0.5%), but the difference was not significant (P =.172). Neurologic complications were lower in the fourth quartile of the study (six of 171; 0.9%) compared with the first quartile (16 of 776; 2.1%), which was likely due to fewer patients being examined for carotid stenosis or ischemic stroke and fewer patients with CVD (P =.085)., Conclusion: Age-related vascular disease accounted for the failure to lower the neurologic complication rate of cerebral angiography despite technical advances., (Copyright RSNA, 2003)

Purpose: To evaluate gadolinium-enhanced three-dimensional auto-triggered elliptic centric-ordered (ATECO) magnetic resonance (MR) venography for imaging of the intracranial venous system., Materials and Methods: ATECO MR venography was performed in 23 patients, eight of whom also underwent two-dimensional time-of-flight (TOF) MR venography for imaging of the intracranial venous system. Seventeen predefined venous structures were evaluated on all venograms by two neuroradiologists. Visualization of venous structures was defined as completely visible (including clearly pathologic), partially visible, or not visible. Readers were also asked to compare the visibility of these predefined structures on ATECO and TOF MR venograms, where available., Results: Of the 23 patients, six had dural venous sinus disease. Of the remaining 17 healthy patients, five underwent both ATECO and TOF MR venography and 12 underwent ATECO MR venography alone. On ATECO MR venograms obtained in the healthy patients, visibility of the 17 predefined venous structures was complete in 92% (531 of 578) of evaluations. For the five normal TOF MR venograms, the rate of complete visibility of the same venous structures was 61% (104 of 170). The rate of complete visibility of the large dural venous sinuses was 99% for ATECO MR venograms and 75% for TOF MR venograms., Conclusion: ATECO MR venography provides high-quality images of the intracranial venous anatomy and was superior to TOF MR venography for consistent complete visibility of venous structures., (Copyright RSNA, 2002)

Nine patients with initial magnetic resonance (MR) imaging and clinical findings suggestive of spinal dural arteriovenous fistula (AVF) underwent spinal MR angiography with an autotriggered elliptic centric ordered three-dimensional gadolinium-enhanced technique (hereafter, this MR angiographic technique) before conventional intraarterial angiography. In all nine patients, findings with this MR angiographic technique correctly and precisely localized the spinal dural AVF. Observer error resulted in one case in which the site of the fistula was not prospectively reported but was easily identified retrospectively on the spinal MR angiogram.

Auto-triggered elliptic centric-ordered three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography was compared with 3D multiple overlapping thin-slab acquisition time-of-flight (TOF) MR angiography in the evaluation of intracranial arteriovenous malformations (AVMs) in 10 patients. Intraarterial digital subtraction angiography (DSA) was the reference standard. Gadolinium-enhanced MR angiograms were found to be equivalent to DSA images in AVM component depiction in 70%--90% of cases and were consistently superior to TOF MR angiograms.