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(Stroke. 2005;36:2475.)
© 2005 American Heart Association, Inc.

Original Contributions

In Situ ß-Irradiation of a Brain Arteriovenous Malformation Model

Daniel Roy, MD; Jean-Paul Soucy, MD; Neil G. Hartman, PhD; Christian Janicki, PhD; Alain Weill, MD; François Guilbert, MD; Karl Papineau, MD Jean Raymond, MD

From the Departments of Radiology (D.R., A.W., F.G., K.P., J.R.) and Nuclear Medicine (J-P.S.), Centre hospitalier de l’Université de Montréal Notre-Dame Hospital Research Centre, Motreal, Quebec, Canada; Department of Medical Physics (C.J.), McGill University Health Centre, Montreal, Quebec, Canada; and Department of Radiology (N.G.H.), School of Clinical Medicine, University of Cambridge, United Kingdom.

Correspondence to Daniel Roy, MD, Centre hospitalier de l’Université de Montréal–Hôpital Notre-Dame, Department of Radiology, 1560 Sherbrooke E, Suite M-8203, Montreal, Quebec, Canada H2L 4M1. E-mail daniel.roy.chum{at}ssss.gouv.qc.ca

Background and Purpose— The treatment of large brain arteriovenous malformations (BAVMs) is challenging, and embolization alone is seldom curative. The study goal is to enhance the efficacy of arteriovenous malformation embolization by adding a ß-emitting isotope to the embolic agent.

Methods— The pig rete mirabile was used as a BAVM model. The body distribution of radioactivity was evaluated after selective rete injection of N-butyl,2-cyanoacrylate mixed with ¹³¹I-lipiodol in 8 animals using immediate whole body -scintigraphy. Activities within the whole rete mirabile and selected tissue samples were quantified with a gamma counter immediately after sacrifice. Two pigs were submitted to serial -scintigraphies for 6 weeks to detect delayed isotope leaching. Long-term effects of in situ irradiation were evaluated using a mixture of ¹⁸⁸Re/N-butyl,2-cyanoacrylate in 8 pigs. In 1 animal, autoradiography was performed to evaluate local rete mirabile distribution of the radioactivity. Seven pigs were injected with ¹⁸⁸Re/glue in 1 rete mirabile and with glue only on the opposite side, and the degree of vascular occlusion of both sides was compared on histology at 2 (n=2) or 6 months (n=5).

Results— There was negligible activity outside the target. Radiation caused occlusion of vessels unreached by the glue itself but in the vicinity of the radioactive source in 5 of 7 rete mirabile.

Conclusions— Selective deposition of a ß-emitter inside a BAVM model may be achieved by current embolization techniques. The adjunct use of an isotope may increase the efficacy of embolization.

Key Words: arteriovenous malformation • embolization • experimental model • radiation therapy