Analysis of complications of intracranial arteriovenous malformations treated through transve-nous approach

Abstract

Objective To explore the complications and preventive measures of intracranial arteriovenous malformations treated by transvenous approach. Methods We performed a prospective single-center study among 18 consecutive patients with ruptured intracranial arteriovenous malformations who underwent treatment through transvenous approach and analyzed perioperative complications and preventive measures. All those patients underwent operation at Cerebrovascular Division of Interventional Department, People’s Hospital of Zhengzhou University from November 2016 to May 2018. The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients. Results The procedure was technically feasible in 16 of 18 cases. Among the 16 patients, immediate angiographic obliteration was achieved in 14 patients and over 85% volume of nidus was occluded in 2. The remaining 2 cases did not undergo transvenous embolization due to the failure of microcatheter navigation. Perioperative complications were reported in 4 cases. Intraoperative hemorrhage occurred in 2 cases and both were intraventricular hemorrhage. Postoperative hemorrhage occurred in 2 cases and the site of hemorrhage was in the thalamus which broke into the ventricle, splenium of corpus callosum and the fourth ventricle. Eighteen cases were followed up for 1-18 months with a median of 10.5 months. The mRS scores were 2 in 1 case, 1 in 4 and 0 in 13 cases. Angiography imaging was achieved in 10 patients with a median of 4.5(2-9)months post operation. None of the patients had recurrence of the nius during the follow-up period. Conclusions Cerebral hemorrhage is the most common complication of transvenous embolization of intracranial arteriovenous malformations. Transvenous embolization of intracranial arteriovenous malformations seems effective if complications could be prevented. Key words: Intracranial arteriovenous malformations; Embolization, therapeutic; Complications; Cerebral hemorrhage