Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery.

Kun Hou,Jinlu Yu,Chao Li,Han Su

doi:10.3389/fneur.2020.609461

Abstract

Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

Highlights

A brain arteriovenous malformation (BAVM) is a common congenital vascular disease that belongs to the abnormal nidus between arteries and veins, which lacks an intervening capillary network and is characterized by a complex, tangled web of abnormal vessels [1, 2]
A retrospective study was performed for patients who were admitted to The First Hospital of Jilin University diagnosed with BAVMs mainly supplied by the posterior cerebral artery (PCA) system from January 2015 to December 2019
For type Ia, the posterior choroidal artery (PchA) was the only source of arterial supply, while type Ib received additional blood supply from other sources, which included the perforating artery from the P1 segment of the PCA, the anterior choroidal artery (AchA), the anterior cerebral artery (ACA), and so on

Summary

Introduction

A brain arteriovenous malformation (BAVM) is a common congenital vascular disease that belongs to the abnormal nidus between arteries and veins, which lacks an intervening capillary network and is characterized by a complex, tangled web of abnormal vessels [1, 2]. A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres and near the posterior part of the corpus callosum and the deep cerebral venous system [5]. The feeding arteries of the PCA-supplied BAVMs (PCA-BAVMs) are complex, and they often drain to the deep venous system. Few studies have investigated the angiographic characteristics and endovascular treatment (EVT) for BAVMs in this area. In this study, we conducted a retrospective single-center investigation of the patients who were diagnosed with PCA-BAVMs. A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area

Methods

Results

Discussion

Conclusion