Endovascular Treatment of Intracranial Aneurysms Associated with Brain Arteriovenous Malformations

Abstract

Objective Brain arteriovenous malformation (AVM) is frequently associated with the presence of intracranial aneurysms, which increase hemorrhage rates resulting in unfavorable outcomes. We report our experience with endovascular treatment (EVT) of intracranial aneurysms associated with AVM. Methods Between March 2010 and February 2017, we treated 274 patients with AVMs. Among them, 27 (9.9%) patients with intracranial aneurysms associated with AVM were treated endovascularly. Clinical and radiographic data for these patients were retrospectively reviewed. Results We treated 32 aneurysms (10 intranidal and 22 proximal aneurysms) in 27 patients. The most frequent presenting symptoms were hemorrhage (59.3%) caused by an AVM nidus in 7 cases and by aneurysm rupture in 9 cases. Of 22 proximal flow-related aneurysms, we performed a simple coiling technique in 16 aneurysms and 6 parent artery occlusions. For 10 intranidal aneurysms, we performed targeted embolization with liquid embolic materials, such as n-Butyl cyanoacrylate or Onyx. There were three procedure-related complications and only one patient suffered transient hemiparesis. Favorable outcome (modified Rankin Scale, mRS 0-2) was achieved in 18 (66.7%) patients and unfavorable outcome (mRS 3-6) in 9 (33.3%) patients, including one death. Conclusion When facing intracranial aneurysms associated with AVMs, EVT might be a useful treatment option for proximal and intranidal aneurysms. Keywords: Brain arteriovenous malformation; Endovascular treatment; Flow-related aneurysm; Intranidal aneurysm.