Adjuvant use of ε-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae

David F Kallmes, W. F. Marx, M. E. Jensen, H. J. Cloft, H. M. Do, G. Lanzino, K. West, J. E. Dion

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

We report our experience with the use of the antifibrinolytic agent ε-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.

Original languageEnglish (US)
Pages (from-to)302-308
Number of pages7
JournalNeuroradiology
Volume42
Issue number4
DOIs
StatePublished - Apr 2000
Externally publishedYes

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Aminocaproic Acid
Arteriovenous Fistula
Fistula
Central Nervous System Vascular Malformations
Thrombosis
Antifibrinolytic Agents
Therapeutics
Vein of Galen Malformations
Angiography
Morbidity

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Adjuvant use of ε-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae. / Kallmes, David F; Marx, W. F.; Jensen, M. E.; Cloft, H. J.; Do, H. M.; Lanzino, G.; West, K.; Dion, J. E.

In: Neuroradiology, Vol. 42, No. 4, 04.2000, p. 302-308.

Research output: Contribution to journalArticle

Kallmes, DF, Marx, WF, Jensen, ME, Cloft, HJ, Do, HM, Lanzino, G, West, K & Dion, JE 2000, 'Adjuvant use of ε-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae', Neuroradiology, vol. 42, no. 4, pp. 302-308. https://doi.org/10.1007/s002340050890
Kallmes, David F ; Marx, W. F. ; Jensen, M. E. ; Cloft, H. J. ; Do, H. M. ; Lanzino, G. ; West, K. ; Dion, J. E. / Adjuvant use of ε-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae. In: Neuroradiology. 2000 ; Vol. 42, No. 4. pp. 302-308.
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