A CLINICAL AND NEUROPATHOLOGIC STUDY OF SILK SUTURE AS AN EMBOLIC AGENT FOR BRAIN ARTERIOVENOUS-MALFORMATIONS

PURPOSE: To evaluate the safety and efficacy of silk suture as an agen t for preoperative embolization of cerebral arteriovenous malformation s. METHODS: Clinical and histopathologic results were analyzed in six patients who underwent embolization of cerebral arteriovenous malforma tions using silk suture in combination with other agents. RESULTS: Thr ee of the patients treated with silk hemorrhaged after embolization, a nd two of these patients died. Neuropathologic analysis of four patien ts showed acute perivascular inflammation, sometimes quite severe. CON CLUSIONS: The inflammatory response to silk may explain its effectiven ess in producing vascular occlusion. However, a fulminate vasculitis t heoretically can predispose to delayed hemorrhage. Other problems with silk include the pressure required to inject the agent and the inabil ity to determine the final site of deposition of the silk. Although ot her embolic agents may share some of these potential difficulties, we feel that the disadvantages outweigh the advantages of silk as an embo lic agent.