*Article*

**Citation:**

#### **Safety of Catheter Embolization of Pulmonary Arteriovenous Malformations—Evaluation of Possible Cerebrovascular Embolism after Catheter Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia/Osler Disease by Pre- and Post-Interventional DWI**

**Guenther Schneider \*, Alexander Massmann, Peter Fries, Felix Frenzel, Arno Buecker and Paul Raczeck**

> Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 1,66421 Homburg, Germany; Alexander.Massmann@uks.eu (A.M.); peter.fries@uks.eu (P.F.); felix.frenzel@uks.eu (F.F.); arno.buecker@uks.eu (A.B.); paul.raczeck@uks.eu (P.R.)

**\*** Correspondence: dr.guenther.schneider@uks.eu; Tel.: +49-6481-1624600; Fax: +49-6481-1624606

**Abstract:** Background. This paper aimed to prospectively evaluate the safety of embolization therapy of pulmonary arteriovenous malformations (PAVMs) for the detection of cerebral infarctions by preand post-interventional MRI. Method One hundred and five patients (male/female = 44/61; mean age 48.6+/ −15.8; range 5–86) with pre-diagnosed PAVMs on contrast-enhanced MRA underwent embolization therapy. The number of PAVMs treated in each patient ranged from 1–8 PAVMs. Depending on the size and localization of the feeding arteries, either Nester-Coils or Amplatzer vascular plugs were used for embolization therapy. cMRI was performed immediately before, and at the 4 h and 3-month post-embolization therapy. Detection of peri-interventional cerebral emboli was performed via T2w and DWI sequences using three different b-values, with calculation of ADC maps. Results Embolization did not show any post-/peri-interventional, newly developed ischemic lesions in the brain. Only one patient who underwent re-embolization and was previously treated with tungsten coils that corroded over time showed newly developed, small, diffuse emboli in the post-interventional DWI sequence. This patient already had several episodes of brain emboli before re-treatment due to the corroded coils, and during treatment, when passing the corroded coils, experienced additional small, clinically inconspicuous brain emboli. However, this complication was anticipated but accepted, since the vessel had to be occluded distally. Conclusion Catheter-based embolization of PAVMs is a safe method for treatment and does not result in clinically inconspicuous cerebral ischemia, which was not demonstrated previously.

**Keywords:** hereditary hemorrhagic telangiectasia/HHT/osler's disease; cerebral ischemic lesions; catheter based embolization therapy; pulmonary arteriovenous malformations
