Abstract
The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs. Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes. Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS ≤ 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21). Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment.
Highlights
BACKGROUND AND PURPOSEThe efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported
Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment
Brain arteriovenous malformations are characterized by an intervening plexus of abnormal vessels between feeding arteries and draining veins
Summary
Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Key inclusion criteria were as follows: 1) patients with a ruptured brain AVM; 2) patients not suitable for intra-arterial embolization due to the absence of arterial access, narrow arterial feeders, extremely tortuous course, too many feeders, and so forth; and 3) patients in whom lesions were not amenable to surgery or radiosurgery or patients who refused to undergo surgery or radiosurgery (AVMs not amendable to surgery or radiosurgery are defined as cases with modified Spetzler-Martin grades of IIIþ, IV, and V based on modification of the Spetzler-Martin scale and those with scores of >1.5 based on Pollock-Flickinger grading scale, which are proved have high rates of iatrogenic complications); and 4) patients with
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