Abstract
PURPOSE: A scanning electron microscopic (SEM) study was performed to examine thrombus induced by a micro platinum coil embolized into a feeding artery of arteriovenous malformation (AVM). CASE: A 31-year-old man was referred for treatment of right frontal AVM, 3 cm in diameter, fed mainly by the right anterior and middle cerebral arteries. Almost all feeders were occluded after two-staged super selective transarterial embolization by polyvinyl alcohol (PVA) particles and proximal feeder occlusion by micro platinum coils. However, the AVM resulted in feeders recanalization three month later. Six months later, open surgery was granted. The AVM was re-embolized presurgically by PVA and coil, and surgical total extirpation of the AVM was achieved without any neurological deficit a week later. RESULT: The SEM study revealed that although the vessel lumen around and distal to the coil were packed with RBCs, the thrombus was not organized, looking very fragile. CONCLUSION: Micro coil embolization of AVM feeder seems to be only effective temporally because coil does not produce organized thrombus. Thrombus induced by the coil could be subjective to break down, and the artery would recanalize sooner or later.
