Pelz D M, Lownie S P, Fox A J, Hutton L C
Department of Diagnostic Radiology, University Hospital, University of Western Ontario, Canada.
AJNR Am J Neuroradiol. 1995 Jan;16(1):19-26.
To describe symptomatic pulmonary emboli from brain arteriovenous malformation embolization with liquid acrylates and to analyze the reasons for these complications and describe preventive techniques.
The clinical records of 182 patients embolized with acrylate glue since 1978 for treatment of brain AVMs were searched for evidence of symptomatic pulmonary complications. Originally iso-butyl-2-cyanoacrylate and more recently n-butyl-2-cyanoacrylate were used in all patients. Arteriovenous malformation morphology, amounts and techniques of glue injection, and clinical and radiologic investigations in the symptomatic patients were recorded.
Three patients had pulmonary symptoms within 48 hours of glue injection. One patient with a left frontal arteriovenous malformation had embolization with an isobutyl-2-cyanoacrylate/pantopaque/acetic acid mixture; severe pleuritic chest pain developed 2 days later. One patient with a left temporal and one with a left cerebellar arteriovenous malformation had embolization with n-butyl-2-cyanoacrylate/lipiodol mixtures; a cough, pleuritic chest pain, and bloody sputum developed in both within 24 hours. Two patients experienced a significant drop in PO2. No flow-arrest techniques were used for any of the injections in these three patients. All patients demonstrated significant changes on chest x-ray and CT chest examinations. All were treated conservatively and recovered spontaneously.
Symptomatic pulmonary complications can occur after acrylate glue injection, particularly when delivery systems without flow arrest are used in high-flow vascular brain lesions. Techniques using acetic acid to delay polymerization time and "sandwich" techniques in which glue is pushed with dextrose are also more susceptible to this complication.
描述使用液态丙烯酸酯栓塞脑动静脉畸形后出现症状性肺栓塞的情况，分析这些并发症的原因并描述预防技术。
检索1978年以来182例使用丙烯酸酯胶栓塞治疗脑动静脉畸形患者的临床记录，以寻找症状性肺部并发症的证据。所有患者最初使用异丁基-2-氰基丙烯酸酯，最近使用正丁基-2-氰基丙烯酸酯。记录有症状患者的动静脉畸形形态、胶水注射量和技术，以及临床和影像学检查情况。
3例患者在胶水注射后48小时内出现肺部症状。1例左侧额叶动静脉畸形患者使用异丁基-2-氰基丙烯酸酯/泛影葡胺/乙酸混合物进行栓塞；2天后出现严重的胸膜炎性胸痛。1例左侧颞叶和1例左侧小脑动静脉畸形患者使用正丁基-2-氰基丙烯酸酯/碘油混合物进行栓塞；两人均在24小时内出现咳嗽、胸膜炎性胸痛和咯血。2例患者的动脉血氧分压显著下降。这3例患者的任何一次注射均未使用血流阻断技术。所有患者的胸部X光和胸部CT检查均显示有明显变化。所有患者均接受保守治疗并自行康复。
注射丙烯酸酯胶后可发生症状性肺部并发症，尤其是在高流量脑血管病变中使用无血流阻断的输送系统时。使用乙酸延迟聚合时间的技术以及用葡萄糖推注胶水的“三明治”技术也更容易出现这种并发症。
