Reply to: Occipital artery: a not so poor artery for the embolization of lateral sinus dural arteriovenous fistulas with Onyx

We thank the authors for their letter in regards to our article.1 We would like to offer the following replies:

We agree the middle meningeal artery (MMA) is usually, in a non-pathological state, smaller than the occipital artery. However, with increased flow demand (such as that created by a dural fistula), vessels can enlarge. This was demonstrated in our patient (in figure 2 of our article), where the posterior branch of the MMA is essentially the same size as the occipital artery. Hence decisions regarding the targeted arterial pedicle need to take individual patient factors into consideration.

The authors of the letter above state that Onyx usually progresses easily through the MMA. In our experience, progression of Onyx distally also depends on the successful formation of a good plug; this can be aided by distal wedging, but plug formation can still be a step which can...

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2sXLOv3
via IFTTT