Routine monitoring of arterial pressure in a brain AVM during embolisation: a diagnostic tool

ABSTRACT

Identification of normal cerebral arteries in the vicinity of a cerebral arteriovenous malformation [AVM] is essential in order to minimize the risk of morbidity and mortality related to the procedure. The identification of these arteries depends on the skill and experience of the Interventionist. When the angio-architecture is complex or unclear, routine monitoring of cerebral arterial pressure may be a useful tool to assist the Interventionist, especially the less experienced one. In a patient with a remnant high flow brain AVM, a pressure recording in a distal artery immediately before an intended deposit of glue revealed an unexpectedly high pressure of 61 mmHg compared to previously recorded pressures of 29 mmHg in a distal feeder and 21 mmHg in the nidus, indicating that the vessel may not only be feeding the AVM but also supplying brain parenchyma making it unsuitable for embolisation