C63 Transvenous approach to intracranial arteriovenous malformation embolization

<h3>Introduction</h3> Traditionally endovascular approach to management of intracranial arteriovenous malformations have been through trans arterial embolization. However, some AVMs with inaccessible arterial route pose significant therapeutic challenges and transvenous embolization can be considered as a promising alternative for such cases to achieve complete nidus obliteration. <h3>Case Description</h3> A 24 year-old male presented with previous history of craniectomy for intraparenchymal haemorrhage due to ruptured AVM in right temporo-parietal region 5 months ago. CT angiography and DSA revealed an AVM with en passage feeders from right middle cerebral artery and a single draining vein with deep venous drainage. Due to the presence of en passage feeders, the AVM was deemed unsuitable for transarterial embolization. A decision was made to proceed with transvenous embolization. Using right internal jugular vein access , a microcatheter was navigated through a guiding catheter into the draining vein of the AVM distally so as to reach as close to the nidus as possible. Onyx-18 was slowly injected retrogradely into the nidus with a balloon microcatheter positioned proximally. Complete angiographic obliteration of the AVM was achieved. The patient showed no neurological deficit post-procedure and follow up DSA at 3 months confirmed occlusion of the AVM nidus. <h3>Conclusions</h3> This case highlights the efficacy of transvenous embolization as a curative option in select AVMs, especially in cases with a compact nidus, a single draining vein, and deep or eloquent locations. As experience with this technique grows, it may become an increasingly valuable tool in the AVM management. <h3>Conflict of Interest</h3> No