Treatment of PAVM Persistence After Coil Embolization

Brian Funaki, MD

Professor and Chief Vascular and Interventional Radiology

University of Chicago Medicine

A previously healthy 35-year-old man suffered 3 consecutive strokes over several months.
Discovered to have a pulmonary arteriovenous malformation and paradoxic emboli.
He underwent coil embolization at an outside hospital. After CT scanning, persistent flow through the coil pack into the malformation was revealed.
Embolization was planned using LOBO (Low-profile Braided Occluder). The LOBO device was required to track through tortuous anatomy; the LOBO device articulates which allows the occluder to track around curves without causing catheter retraction.
A single LOBO-3 vascular occluder was deployed immediately adjacent to the coil pack. There was complete and immediate occlusion of the malformation.
Total fluoroscopy time was 18.4 minutes and air kerma was 1124 mGy. The patient was discharged without further intervention and was asymptomatic on 1 week follow up.

Figure 1: Digital subtraction angiogram confirming CTA finding operfusion (red arrow) through coil pack.

Figure 2: Fluoroscopic image showing deployed LOBO-3.

Figure 3: Subselective angiogram showing occlusion of PAVM.

The LOBO device has many desirable attributes including immediate occlusion, flexible sizing, precise placement, radial strength to preclude migration, reduced streak artifact on follow up CT, and excellent trackability in tortuous vessels.