nitinol and Telangiectasia--Hereditary-Hemorrhagic

To evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT).. Twenty-five patients (average age 35 y; range, 15-56 y) with hereditary hemorrhagic telangiectasia (HHT) and de novo PAVM embolization with at least 1 MVP between November 2015 and May 2017 were retrospectively evaluated. Retrospective data were also obtained from prior embolization procedures in the same patient population with other embolic devices dating back to 2008. Technical success, complications, PAVM persistence rates, and category of persistence were analyzed.. In 25 patients, 157 PAVMs were treated: 92 with MVP, 35 with AMPLATZER vascular plug (AVP), 6 with AVP plus coils, and 24 with coils. The per-PAVM technical success rates were 100% with MVP; 97%, AVP; 100%, AVP plus coils; and 100%, coils. PAVM persistence rates and median follow-up were as follows: MVP, 2% (1/92) (510 d); AVP, 15% (3/20) (1,447 d); AVP plus coils, 20% (1/5) (1,141 d); coils, 46.7% (7/15) (1,141 d). Persistence owing to recanalization for MVP, AVP, AVP plus coils, and coils was 2%, 15%, 0%, and 33%. No difference was found between persistence rates of MVP vs AVP (P = .098). Embolization with a vascular plug (MVP or AVP) with or without coils had a statistically significant lower persistence rate (5.4%) than embolization with coils alone (46.7%) (P = .022).. PAVM embolization with MVP had a high technical success rate and a low persistence rate comparable to AVP and lower than coil embolization alone.

Topics: Adolescent; Adult; Alloys; Arteriovenous Malformations; Coated Materials, Biocompatible; Embolization, Therapeutic; Equipment Design; Female; Humans; Male; Middle Aged; Polytetrafluoroethylene; Pulmonary Artery; Pulmonary Veins; Retrospective Studies; Telangiectasia, Hereditary Hemorrhagic; Time Factors; Treatment Outcome; Young Adult

Pulmonary arteriovenous malformations (PAVMs) are a relatively uncommon but potentially life-threatening condition manifested by cyanosis, paradoxical embolization, brain abscess, and rupture. A variety of transcatheter closure devices have been used to occlude PAVMs however risks of device embolization, incomplete closure, or large delivery systems have made each of these methods sub-optimal. The Amplatzer Vascular Plug II (AVP II) is a new multisegmented, woven nitinol cylinder that can be deployed through a small delivery catheter. The AVP II differs from the original AVP in having a finer, more tightly woven nitinol frame and three, rather than one occlusive segment. The authors report the first use of the AVP II for occlusion of bilateral large arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia.

Topics: Adolescent; Alloys; Arteriovenous Malformations; Cardiac Catheterization; Catheterization, Swan-Ganz; Equipment Design; Humans; Male; Pulmonary Artery; Pulmonary Veins; Telangiectasia, Hereditary Hemorrhagic; Tomography, X-Ray Computed; Treatment Outcome