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Treatment of Arteriovenous Malformations with Hydrocoils in a Swine Model

Arteriovenous malformations (AVM) of the brain are the most common symptomatic congenital vascular malformation of the central nervous system, with significant associated morbidity and mortality. This study compared the feasibility and efficacy of treating AVMs by embolization with hydrocoils with similar treatment with bare platinum coils, using the swine rete mirabile as a model. A right carotid-jugular fistula was created in ten swine. A microcatheter was positioned into the rete mirabile, which was unilaterally (contralateral to the fistula) embolized with hydrocoils in six and bare platinum coils in four swine. Angiograms were evaluated during and immediately after embolization. Embolization with complete cessation of blood flow in the unilateral rete mirabile was achieved in all animals treated with hydrocoils. The number of coils needed varied from four to seven (diameter 2–4 mm; mean coil length 22.3 cm). Embolization with platinum coils of similar number (seven) and slightly longer length (mean 37.75 cm) had a minimal effect on blood flow, resulting in occlusion of only small compartments. No immediate complications were noted with either coil. Hydrocoils are more effective in achieving embolization than bare platinum coils. Expansion of the hydrocoil over only a few minutes allows precise placement and stabilization of the coil before detachment. Hydrocoils can be safely placed into small vessels. This approach may be particularly useful to decrease the flow rate, as a first stage of AVM embolization in high flow AVMs that contain arteriovenous fistulae.