SYMPTOMATIC PULMONARY COMPLICATIONS FROM LIQUID ACRYLATE EMBOLIZATIONOF BRAIN ARTERIOVENOUS-MALFORMATIONS

PURPOSE: To describe symptomatic pulmonary emboli from brain arteriove nous malformation embolization with liquid acrylates and to analyze th e reasons for these complications and describe preventive techniques. METHODS: The clinical records of 182 patients embolized with acrylate glue since 1978 for treatment of brain AVMs were searched for evidence of symptomatic pulmonary complications. Originally iso-butyl-2-cyanoa crylate and more recently n-butyl-2-cyanoacrylate were used in all pat ients. Arteriovenous malformation morphology, amounts and techniques o f glue injection, and clinical and radiologic investigations in the sy mptomatic patients were recorded. RESULTS: Three patients had pulmonar y symptoms within 48 hours of glue injection. One patient with a left frontal arteriovenous malformation had embolization with an isobutyl-2 -cyanoacrylate/pantopaque/acetic acid mixture; severe pleuritic chest pain developed 2 days later. One patient with a left temporal and one with a left cerebellar arteriovenous malformation had embolization wit h n-butyl-2-cyanoacrylate/lipiodol mixtures; a cough, pleuritic chest pain, and bloody sputum developed in both within 24 hours. Two patient s experienced a significant drop in Po-2. No flow-arrest techniques we re used for any of the injections in these three patients. All patient s demonstrated significant changes on chest x-ray and CT chest examina tions. All were treated conservatively and recovered spontaneously. CO NCLUSIONS: Symptomatic pulmonary complications can occur after acrylat e glue injection, particularly when delivery systems without Bow arres t are used in high-flow vascular brain lesions. Techniques using aceti c acid to delay polymerization time and ''sandwich'' techniques in whi ch glue is pushed with dextrose are also more susceptible to this comp lication.