Embolization of cerebral arteriovenous malformations with silk suture particles prior to stereotactic radiosurgery

Dale Ding, Jason P. Sheehan, Robert M. Starke, Christopher R. Durst, Daniel M. Raper, Jordan R. Conger, Avery J. Evans

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


We aimed to determine the long term durability of silk suture and polyvinyl alcohol (PVA) particle embolization (SPE) of arteriovenous malformations (AVM), and to evaluate the outcomes following multimodality management of AVM with combined SPE and stereotactic radiosurgery (SRS). A general supposition among neurointerventionalists is that embolization of cerebral AVM with silk sutures and PVA particles does not yield a durable occlusion. We performed a retrospective review of all AVM patients treated at our institution with combined SPE and SRS. After extracting the baseline, embolization and SRS data for each patient, the durability of SPE was determined by evaluating the postembolization recanalization between the last procedural angiogram and the most recent neuroimaging. Four AVM patients who underwent a total of nine SPE procedures through 21 arterial pedicles were included for the analyses. The nidus volumes were 5.8-75 cm3 and the Spetzler-Martin grades were II and V in one patient and III in two patients. The median degree of devascularization per procedure was <25%. There were no procedural complications, with all patients maintaining functional independence after embolization (modified Rankin scale score 0-2). After a median follow-up duration of 27 months (range: 23-36), there were no patients with recanalization. SRS (marginal dose 13-18 Gy) resulted in 40 to >95% volume reduction. Following SRS, one patient remained asymptomatic, two patients improved, and one patient deteriorated due to a latency period AVM hemorrhage. In conclusion, SPE can safely provide durable AVM devascularization, therefore, appropriately selected nidi can be effectively treated with combined SPE and SRS.

Original languageEnglish (US)
Article number6072
Pages (from-to)1643-1649
Number of pages7
JournalJournal of Clinical Neuroscience
Issue number10
StatePublished - Oct 1 2015
Externally publishedYes


  • Embolization
  • Gamma knife
  • Intracranial arteriovenous malformations
  • Particles
  • Radiosurgery
  • Silk
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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