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One of the most distressing duties of a physician is to tell a patient who has bled from a cerebral arteriovenous malformation that nothing can be done to prevent a recurrence. The development of angiographically controlled embolization of arteriovenous malformations has opened a new therapeutic avenue for inoperable cases.
To innovate is to challenge and, as Dr Wade points out, the fragmented knowledge that we have about the results with the new technique shows no obvious superiority over our equally imperfect knowledge of the natural history. Moreover, the mechanism of "intracranial steal" is questioned and the known and potential complications of embolization are stressed.
Drs Fox and Viñuela document their evolving experience with clear recognition of the limitations of the technique. On the other hand, it is likely that technical advances and the meticulous assessment of the many measurable characteristics of each case will define a role of therapeutic embolization
Hachinski V. Therapeutic Cerebral Embolization. Arch Neurol. 1986;43(5):511. doi:10.1001/archneur.1986.00520050083030
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