Intracranial Arteriovenous and other Vascular Malformations, have a high rate of bleeds and are seen in about 1% of the general population. These lesions are difficult to treat because of size, location and morphology. The treatment options include; surgical resection, endovascular embolization or radiosurgery. Treatment strategies can be a single treatment option or in combination however, each vascular lesion has to be evaluated to best fit the patient’s needs and outcomes.
The endovascular treatment has had much success in the past and consists of placement of a microcatheter system into the filling vessel/pedicle or directly into the nidus of the lesion. Once catheter placement has been achieved, transcatheter delivery of an embolic agent to slow or completely occlude the flow into these feeding pedicles and nidus. Although in some vascular lesion, a single agent such as a liquid agent can achieve stasis, multiple agents may be necessary to achieve the same outcome in lesions that are high-flow or complex.
The Berenstein HydroFlow Coil-BHF was developed to be deployed to a predetermined location within a vascular architecture to slow the flow into the lesion. The BHF coil is a Hydrogel coil with no platinum frame but visible on fluoroscopy, it has minimal expansion but very soft, pliable and easily deliverable through a microcatheter system. Once the BHF has been delivered to the target location, a complementary agent such as onyx, NBCA, alcohol or PVA can then be safely delivered. The BHF will act as backstop for the other agents to attach to or to slow the flow and thus achieving stasis within the AVM.
The HydroFlow Arteriovenous Malformation Registry- HAMR was developed to collect clinical data to demonstrate the safety and efficacy of the BHF. The registry will be a retrospective and prospective multicenter international registry of 40 patients. The Primary Investigator will be Dr. Karel terBrugge and the Core lab for angiographic evaluation will be Dr. Robert Willinsky both from the Toronto Brain and Vascular Malformation Study Group at Toronto Western Hospital.