Adjuvant use of e-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae |
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Authors: | D F Kallmes W F Marx M E Jensen H J Cloft H M Do G Lanzino K West J E Dion |
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Institution: | (1) Department of Radiology, Box 170, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA e-mail: wfm8p@virginia.edu, Tel.: + 1-8 04-9 24 97 19, Fax: + 1-8 04-9 82 16 18, US;(2) Department of Radiology, Emory University, Atlanta, Georgia, USA, GE;(3) Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA, US;(4) Department of Pharmacy, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA, US |
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Abstract: | We report our experience with the use of the antifibrinolytic agent ɛ -aminocaproic acid (EACA), Amicar, as an adjuvant to endovascular treatment of cranial arteriovenous fistulae. We also review
applications of antifibrinolytic agents to neurovascular disorders and discuss the mechanism of action, dosing strategy, contraindications,
and possible complications associated with the use of EACA. We identified 13 patients with cranial arteriovenous fistulae
(five direct carotid cavernous fistulae CCF], seven dural arteriovenous fistulae DAVF], and one vein of Galen malformation)
who received EACA as an adjunct to endovascular treatment. In all cases embolic coils were the primary embolic agent. We reviewed
the modes of initial endovascular therapy and angiographic findings immediately thereafter and the response to EACA. Two direct
CCF and two DAVF were completely thrombosed on follow-up angiography, and two DAVF demonstrated diminished flow after EACA
therapy. Seven fistulae did not respond to EACA. Four of eight tightly coiled fistulae thrombosed, while none of five loosely
coiled fistulae thrombosed. None of four cases with a residual fistula separate from the coil mass underwent thrombosis with
EACA, while four of nine cases without a separate fistula thrombosed. There was no morbidity related to EACA therapy. EACA
may thus be useful as an adjunct to endovascular treatment of cranial arteriovenous fistulae. Loose or incomplete coil packing
of the fistula predicts a poor response to EACA therapy.
Received: 18 March 1999 Accepted: 11 August 1999 |
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