Malformation fills via PCOM and right PCA branches, and by R (+++) and L (++) ACA subfornical branches. Complete limbic arch. Distal right ACA demonstrates a large high flow fistula into the vein of Galen malformation.
Attempts to coil the artery at the fistula to allow subsequent glue failed, due to coil prolapsing into VGAM. Hence the malformation itself was embolised with platinum coils to provide basket to allow subsequent occlusion at fistula.
Distal right ACA then 1:1 NBCA - with good occlusion and penetration to the fistulas, but no penetration beyond coil mass in the malformation.
Distal right PCA choroidal branch also embolised (not shown) 1:1.8 NBCA - after coil embolisation from malformation into terminal artery. PCA cortical branches arise within mm's of this large branch - despite slow injection, reflux into a small adjacent branch.
At the end of the procedure there was still flow in the malformation but this was decreased, and an increase in BP was noted during treatment consistent with improved cardiac function.
Angiography courtesy of Prof. Peter Mitchell.