Aneurysms Associated with Brain Arteriovenous Malformations

Rammos, Stylianos K.; Gardenghi, Beatrice; Bortolotti, Carlo; Cloft, Harry J.; Lanzino, Giuseppe

doi:10.3174/ajnr.a4869

Cited by 45 publications

(29 citation statements)

References 29 publications

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“…Nevertheless, because of the overlap of FAs by the parent artery or arterial branch on conventional DSA and the lack of rotational and 3D-reconstruction DSA, 2D-DSA may overlook 6.8%-21% of intracranial aneurysms, particularly, aneurysms of Ͻ3 mm. [18][19][20][21] In our series, the incidence of FAs was 8.8%; this was within the range of previously reported rates but slightly lower than the average detection rate. The lower detection rate was likely due to the lack of superselective microcatheter DSA in all patients and the absence of rotational/reconstruction DSA in 42% of patients in our series.…”

Section: Discussionsupporting

confidence: 84%

Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery

Tsuei

Luo

Fay

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The natural history of flow-related aneurysms after obliteration of brain arteriovenous malformations is poorly understood. The purpose of this study was to evaluate the angioarchitecture and morphologic change in flow-related aneurysms after gamma knife surgery of brain arteriovenous malformations. MATERIALS AND METHODS:During a 12-year period, 823 patients with brain arteriovenous malformations underwent gamma knife surgery at our institution with complete peritherapeutic angiographic evaluation. From this population, a series of 72 patients (8.8%) with 111 flow-related aneurysms were enrolled (1.5 aneurysms per patient). There were 43 men and 29 women; ages ranged from 18 to 72 years (mean, 43 years). The morphologic change of flow-related aneurysms was longitudinally evaluated before and after obliteration of brain arteriovenous malformations. After gamma knife surgery, angiographic follow-up varied from 26 to 130 months (mean, 58 months). RESULTS:All flow-related aneurysms were small (mean, 4.1 mm; range, 2-9 mm). There were 72 proximal flow-related aneurysms (mean size, 4.3 mm) and 39 distal flow-related aneurysms (mean size, 3.7 mm). Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms than in proximal flow-related aneurysms (P Ͻ .001). Smaller flow-related aneurysms (Ͻ5 mm) tended to spontaneously occlude after obliteration of brain arteriovenous malformations (P ϭ .036). Two patients had ruptures of proximal flow-related aneurysms at 27-and 54-month follow-ups, respectively. CONCLUSIONS:Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms due to occlusion or normalization of distal feeders. Smaller flow-related aneurysms also tended to spontaneously thrombose after obliteration of brain arteriovenous malformations. The rate of flow-related aneurysm rupture in our series was similar to that of natural intradural aneurysms. ABBREVIATIONS: ACA ϭ anterior cerebral artery; BAVM ϭ brain arteriovenous malformation; FA ϭ flow-related aneurysm; GKS ϭ gamma knife surgery

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Section: Discussionsupporting

confidence: 84%

Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery

Tsuei

Luo

Fay

et al. 2019

AJNR Am J Neuroradiol

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“…Most classifications distinguish unrelated arterial aneurysms, proximal, flow-related feeder aneurysms and intranidal aneurysms [12,32,33,34,35,36]. The reported frequency of concurrent arterial aneurysms varies widely from 2.7 to 58% [37]. Most publications, however, report rates between 10 and 20% [34].…”

Section: Discussionmentioning

confidence: 99%

Early Rebleeding after Brain Arteriovenous Malformation Rupture, Clinical Impact and Predictive Factors: A Monocentric Retrospective Cohort Study

Shotar

Pistocchi²,

Haffaf³

et al. 2017

Cerebrovasc Dis

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Background: Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. This study aimed to identify individual predictive factors of early rebleeding after BAVM rupture and determine its impact on prognosis. Methods: Early rebleeding was defined as a spontaneous intracranial hemorrhage within 30 days of BAVM rupture in patients with nonobliterated BAVMs. One hundred fifty one patients with 158 BAVM hemorrhagic events admitted to a tertiary care center during 14 years were included. Univariate followed by multivariate logistic regression was performed to assess the impact of early rebleeding on in-hospital mortality and modified Rankin Scale (mRS) score beyond 3 months and to identify independent predictors of early rebleeding. Results: Eight early rebleeding events were observed, 6 of which occurred during the first 7 days. Early rebleeding was independently and significantly associated with poor outcome (mRS ≥3 beyond 3 months, p = 0.004) but not with in-hospital mortality (p = 0.9). Distal flow-related aneurysms (p = 0.009) and altered consciousness with a Glasgow coma scale score of 3 (p = 0.01) were independently associated with early rebleeding. Conclusions: Early rebleeding is a severe complication that can occur after BAVM-related hemorrhage. Distal flow-related aneurysms and initial altered consciousness are associated with early rebleeding.

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“…The MR findings represented either a region of active vascular inflammation or a region of encephalomalacia from prior insult. The patient's initial presentation, coupled with the MR findings, necessitated expedient AVM treatment over treatment of the associated unruptured aneurysm for greater concern of AVM rupture [4,5,6,9,10,11,22]. Of note, the patient preferred endovascular treatment modalities.…”

Section: Discussionmentioning

confidence: 99%

“…No consensus currently exists to guide the treatment of intracranial aneurysms associated with AVMs. However, various case series discuss current treatment strategies for surgically managing AVMs with coexisting intracranial aneurysms [4,5,6,9,10,11,19,21,22]. Rammos et al [22] suggest that the spatial relationship between the AVM nidus and the associated aneurysm, in addition to the patient's clinical presentation, should guide treatment decisions and timing.…”

Section: Discussionmentioning

confidence: 99%

Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report

et al. 2018

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Background: An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms. Endovascular treatment of these flow-related aneurysms can offer a cure, while avoiding open surgery. Successful flow-diverting embolization techniques, efficacy, and outcomes have been previously described for a variety of aneurysm types and locations. However, use of a flow diverter has not been previously described for the treatment of high-flow aneurysms on AVM-feeding vessels. Case Presentation: We report 2 cases of large AVMs within eloquent cortex associated with flow-related aneurysms in patients presenting initially with suspected intracerebral hemorrhage secondary to AVM rupture. Discussion: No consensus currently exists to guide treatment of intracranial aneurysms associated with AVMs. Surgical management addressed AVM embolization initially, as the vasculopathology with the highest rupture risk. Subsequently, Pipeline embolization of the associated aneurysms with adequate antiplatelet treatment was performed before scheduled radiosurgery to decrease the risk of AVM rupture or rebleed. This represents a novel and promising use of the Pipeline Embolization Device. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

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Aneurysms Associated with Brain Arteriovenous Malformations

Cited by 45 publications

References 29 publications

Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery

Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery

Early Rebleeding after Brain Arteriovenous Malformation Rupture, Clinical Impact and Predictive Factors: A Monocentric Retrospective Cohort Study

Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report

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