Embolization of cerebral arteriovenous malformations with bucrylate. Experience in a first series of 29 patients.

The experience with embolization of intracerebral arteriovenous malformations (AVMs) with bucrylate (isobutyl-2-cyanoacrylate) in 29 patients is reported. In 9 cases (31%) less than 1/3 of the AVM nidus was occluded, in 12 (41%) 1/3 to 2/3, in 4 (14%) more than 2/3, and total occlusion was only seen in 3 cases (10%). One patient was never embolized, owing to procedure complications. At follow-up angiography in 20 patients, partial revascularization was found in 11 AVMs and further occlusion in 2. Complications occurred in 11 cases (38%). Five patients (17%) suffered from hemorrhage: 2 died, one deteriorated severely and 2 recovered. Unintentional embolization or edema resulted in neurologic deficits in 6 patients (21%), permanent in 3 and reversible in 3. Symptomatic improvement was initially found in 13 patients (45%) but was stable only in 9. In 9 patients (38%) embolization was followed by elective surgery or irradiation. The best results were obtained in small and medium-sized AVMs (less than 6 cm) while there was a high risk of complications and an uncertain palliative effect in large AVMs.