Shimohira Masashi, Hashizume Takuya, Kawai Tatsuya, Muto Masahiro, Ohta Kengo, Suzuki Kazushi, Shibamoto Yuta
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Pol J Radiol. 2015 Feb 7;80:67-71. doi: 10.12659/PJR.892378. eCollection 2015.
Recanalization occurs occasionally, following coil embolization of pulmonary arteriovenous malformations (PAVM), and can lead to ischemic stroke; therefore re-embolization is important. A 1.9-Fr. no-taper microcatheter that can be inserted into a 2.7-Fr. microcatheter (named the triaxial system) has recently become available, and contributes to super-selective catheterization for small or tortuous vessels. The aim of this study was to evaluate the usefulness of re-embolization for recanalization of PAVM using the triaxial system.
MATERIAL/METHODS: Recanalization was diagnosed in 8 patients with 13 PAVMs between June 2011 and November 2012, and re-embolization was attempted with a conventional microcatheter at first in all 13 PAVMs. However, in three of them it failed with the conventional microcatheter, and then the system was exchanged to the triaxial system. Thus, re-embolization using the triaxial system was performed in 3 PAVMs of 3 female patients, with a median age of 63 years (range, 46-73 years). We assessed technical success, complications, and outcome.
The disappearance of recanalization was confirmed by angiography in all re-embolization procedures (technical success rate was 100%). Re-embolization was then successfully achieved inside the original coils, and no branch artery of normal lung tissue was embolized. There were no complications related with this procedure. The blood flow of recanalization was decreased in all cases in a follow-up of 27-33 months (median, 31).
Triaxial system appears to be useful for recanalization of PAVM, especially in difficult cases with a conventional system.
肺动静脉畸形（PAVM）经弹簧圈栓塞后偶尔会出现再通，并可能导致缺血性卒中；因此再次栓塞很重要。一种可插入2.7Fr微导管的1.9Fr无锥度微导管（称为同轴系统）最近已上市，有助于对细小或迂曲血管进行超选择性插管。本研究的目的是评估使用同轴系统对PAVM再通进行再次栓塞的有效性。
材料/方法：2011年6月至2叭2年11月期间，在8例患者共13处PAVM中诊断出再通，所有13处PAVM均首先尝试使用传统微导管进行再次栓塞。然而，其中3处使用传统微导管栓塞失败，随后更换为同轴系统。因此，3例女性患者的3处PAVM使用同轴系统进行了再次栓塞，中位年龄63岁（范围46 - 73岁）。我们评估了技术成功率、并发症及结果。
所有再次栓塞过程中，血管造影均证实再通消失（技术成功率为100%）。然后在原有的弹簧圈内成功实现再次栓塞，未栓塞正常肺组织的分支动脉。该操作无相关并发症。在27 - 33个月（中位时间31个月）的随访中，所有病例再通处的血流均减少。
同轴系统似乎对PAVM再通有用，尤其是在使用传统系统困难的病例中。
