Here we show how to do microcatheter DYNAs to understand compartments of brain AVM and plan embolizations
An incidental AVM was managed conservatively for 3 years, until it ruptured. Suspicion of perinidal aneurysm at rupture location (oval)
Angios — there are two enlarging proximal AICA aneurysms, however these are not where blood is. The culprit aneurysm is hidden in the AVM
DYNA identifies the suspected rupture site. Axial = top; sagittal = bottom left; coronal = bottom right
Microcatheter Injection of SCA — contrast stasis in the pseudoaneurysm
From this position, microdyna is obtained (green) and fused with the right vert global dyna (red). MIP images show the target, as well as some cerebellum
A more selective position is obtained based on the microdyna
Accelerated images of nBCA injection
Post nBCA:lipidol 1:2 injection
DYNA of nBCA cast
Fusion of cast and initial global DYNA. Arrow points to aneurysm with some glue in it. The top right image is misregistered (see halo effect on bone = oval) therefore the glue drop is lateral to the aneurysm. On the upper right image, the misregistration is corrected and glue is where it should be.
Post CT
How to do this?
Global right vert DYNA — 7 second dual volume (DSA DCT) FOV 22 micro dyna no binning protocol. Injection — 3.5 cc/sec for 35 cc, 3 sec delay. Undiluted contrast
MICRO DYNA of the LATERAL branch of the left SCA
Microcatheter = Headway duo 156 cm. Hand injection with 3 cc polycarbonate syringe. Protocol = 7 sec single phase (DCT) 22 cm FOV micro DYNA no binning. Inject for 3 seconds before imaging
Fuse secondary reconstruction the “natural fill” of the global right vert DYNA with the secondary reconstruction of the microDYNA. We know the aneurysm is NOT in this distribution, but want to do this to plan future embo
We now inject the suspected aneurysm-associated branch. Same protocol — Microcatheter = Headway duo 156 cm. Hand injection with 3 cc polycarbonate syringe. Protocol = 7 sec single phase (DCT) 22 cm FOV micro DYNA no binning. Inject for 3 seconds before imaging
AXIAL MIP of the above injection. A lot of cerebellum is here also
We perform a secondary reconstruction and fuse it with the original global right vert dyna
Axial fusion MIPs
Coronal fusion MIPs
A post-injection DYNA is obtained. This needs to be a dual volume injection (native/mask + injection) to see the nBCA better. Protocol as before: Global right vert DYNA — 7 second dual volume (DSA DCT) FOV 22 micro dyna no binning protocol. Injection — 3.5 cc/sec for 35 cc, 3 sec delay. Undiluted contrast. Below is a secondary reconstruction:
