PMC3622349_01
Electroretinogram (ERG) signals showing the baseline signal response (a) Early procedural preembolization ERG signals, (b) Flattening amplitude by about 30% and increased latency by about 10 ms at about 10 min postembolization, (c) Spontaneous return of the normal baseline ERG signal, (d) By the end of the case
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F1
Baseline ERG recording to flash stimulation yielded a polyphasic response with a 25.8 ms latency and an amplitude of 14 muV [Figure 1]. However, 10 min later, as the second left ophthalmic pedicle was about to be accessed for potential embolization, we noted a significant change in ERG (10 ms increase in latency and 30% decrease in amplitude) compared with baseline and signals on the right [Figure 1].
Lateral views preembolization (a, b, c) and postembolization (d, e, f) of a left ophthalmic artery branch to the AVF nidus. The native view postembolization, (d) shows the Onyx glue cast (black arrows). The arterial phase DSA postembolization, (e) shows the vessel cutoff at the proximal end of the Onyx glue cast in the AVF arterial feeding branch (white arrow-head), compared with the filling of this branch seen preembolization, (b) The capillary phase DSA postembolization, (f) shows the enhanced contrast seen filling the left retina (black arrow-heads) compared with preembolization (c)
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F2
DSA was performed [Figure 2a-c] and then a Marathon microcatheter (eV3/Covidien, Irvine, CA) and Mirage 0.008" microwire (eV3/Covidien, Irvine, CA) were used to selectively catheterize the left ophthalmic artery and superselective DSA was performed to confirm the position of the microcatheter tip within the arterial pedicle of the Postembolization DSA showed a more prominent retinal blush suggesting increased flow through the central retinal artery [Figure 2d-f].