Angioarchitectural Characteristics Associated with Complications of Embolization in Supratentorial Brain Arteriovenous Malformation

Abstract

BACKGROUND AND PURPOSE:Embolization is an important therapeutic technique in brain arteriovenous malformations; however, little has been reported on the factors contributing to complications. We retrospectively reviewed a large series of supratentorial brain AVMs to identify the angioarchitectural characteristics that might be associated with the complications of embolization and poor clinical outcomes.

Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

“…In neurosurgery, high 29 grades (≥ III) and deep brain locations 24 are associated with high complication rates. 22 Several surgical technical modifications, 18 such as excision of "non-eloquent" brain parts to obtain surgical access, 12 as well as multimodality treatments, 16 have been described in small case series as solutions for deep AVM treatment with moderate clinical results.…”

“…Lower total occlusion and higher complication rates have been reported for endovascular treatment of AVMs in eloquent and deep locations. 22 Stereotactic radiosurgery (SRS) is usually a feasible treatment modality. Nevertheless, the effective radiation dose is attenuated in deep localizations and higher radiation doses are needed to increase effectiveness, which may result in higher complication rates.…”

Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance

“…Of all the cases reviewed, 13.1% experienced complications, including hemorrhage in 5.7% and ischemia in 5.5%, which are consistent with the reported rates of complications in 6.4%-21% of procedures. [16][17][18][19][20][21][22] Multivariate analysis showed that embolization for infratentorial AVMs was significantly associated with complications. To our knowledge, this study includes the largest number of patients with bAVMs treated by endovascular procedures across multiple centers since the advent of current neuroendovascular techniques.…”

“…26,27 After the introduction of Onyx for AVM embolizations, Bell et al 25 reported their experience of transarterial embolization in 126 patients with bAVMs and concluded that procedure-related complications did not correlate with the Spetzler-Martin grade, but with a novel endovascular grading scale incorporating the number of feeding arteries, eloquence, and the presence of an arteriovenous fistula component. Pan et al 19 categorized complications of AVM embolization using liquid materials into technique-related and non-technique-related. Techniquerelated complications, such as those induced by navigation or removal of the microcatheter and migration of embolic materials, can be overcome by further improvement in the endovascular procedures and devices.…”

“…Complications unrelated to the endovascular technique are mainly associated with angioarchitectural characteristics of bAVMs, including eloquent cortical location or exclusive deep venous drainage. 19 Baharvahdat et al 16 analyzed 846 embolization procedures performed in their institution during a 10-year period and reported that hemorrhagic complications occurred in 11% of cases, including periprocedural arterial perforation (48%) and AVM rupture (52%). They also identified premature venous occlusion as an independent predictor of severe hemorrhagic complication.…”