Abstract Details

Title Induction of Vasodilation to Prevent Ophthalmic Complications Before Middle Meningeal Artery Embolization

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-006

Background Embolization of the Middle Meningeal Artery (MMA) is a minimally invasive procedure used as alternate or adjunctive treatment of chronic subdural hematoma (cSDH). Benefits of MMA embolization are attributed to the targeting of the pathophysiology of cSDH, currently favoring an increased inflammatory response causing immature/leaky neovascularization. The major dural arteries and complications associated with their embolization are thoroughly described in past literature. Unintended embolization of orbital arteries leading to blindness is the most significant hazard associated with MMA embolization.

Objective We present 2 cases demonstrating the success of our technique in treating cSDH while preventing blindness by visualizing the anastomotic vessels between MMA and Ophthalmic Artery (OA) branches after inducing vasodilatation before particle embolization.

Design/Methods After doing an Internal Carotid Artery (ICA) run and ensuring origination of OA from ICA, observing retinal blush, and performing an MMA run, we routinely infused 10-20mcg of Nitroglycerine into the main trunk of MMA through a microcatheter to dilate and better visualize the MMA branches including anastomosis. If the meningeo-ophthalmic collaterals were visualized during the follow-up microcatheter run, we coil embolized the proximal segment of those collaterals through the same microcatheter. We then infused 100-300µm particles through the main branches of the MMA supplying the dura.

Results Of the 39 patients who underwent MMA embolization for cSDH, 5 received MMA/OA collateral variants coil embolization followed by successful particle embolization of all MMA branches supplying the dura without complication. 2 out of these 5 patients' MMA/OA collaterals were not noticed on the initial MMA runs but after vasodilatation.

Conclusions In cSDH patients, few collaterals from MMA to Ophthalmic or Lacrimal branches, visualized after inducing vasodilatation, were safely coil embolized before complete particle embolization of MMA dural branches with no significant complications; suggesting safer embolization of MMA. Our literature search did not find a similar method used in this application.

Authors/Disclosures
Kiana Moussavi, MD (Dartmouth Hitchcock Medical Center) PRESENTER	Ms. Moussavi has nothing to disclose.
Mohammad Moussavi, MD	Dr. Moussavi has nothing to disclose.