In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication.
Settecase, F., Hetts, S. W., Nicholson, A. D., Amans, M. R., Cooke, D. L., Dowd, C. F., … Halbach, V. V. (2016). Superselective intra-arterial ethanol sclerotherapy of feeding artery and nidal aneurysms in ruptured cerebral arteriovenous malformations. In American Journal of Neuroradiology (Vol. 37, pp. 692–697). American Society of Neuroradiology. https://doi.org/10.3174/ajnr.A4584