Cerebral arteriovenous malformations in the era of embolization for angiographic cure: a single-center experience in Egypt

Abstract

BackgroundEmbolization for cerebral arteriovenous malformations (AVMs) has evolved in the last decade with evolution in both equipment and material. Embolization targets have expanded to include angiographic cure.MethodsTo discuss the technical and management outcomes of our first cerebral AVM case series treated with embolization. The clinical, angiographic, treatment, and outcome variables of consecutive cerebral arteriovenous malformation cases, treated with curative embolization, between January 2011 and June 2017 in one regional center, were retrospectively analyzed.ResultsIn 21 patients, 21 AVMs were identified, and 13 patients (61.9%) were males. The mean of the age was 34.24 ± 12.99. Fifteen patients (71.4%) had a history of intracranial hemorrhage, and 10 (47.6%) patients had seizures. Sixteen patients (76.2%) were at grade 1 of modified Rankin Scale (mRS) at admission. The median for modal Spetzler-Martin grade was 2. The average number of arterial feeders was 3. Direct arteriovenous fistulas were found in 4 cases (19.0%). Venous aneurysms were found in 4 cases (19.0%). Seventeen AVMs (80.9%) were considered high bleeding risk lesions. Forty-three embolization sessions were done. Early hemorrhage occurred in 3 sessions (7.0%). Vessel perforation occurred 1 session (2.3%). Poor outcome occurred in 1 patient that was discharged at grade 3 mRS. Angiographic cure was achieved in 9 patients (42.9%). The average size reduction was 65%.ConclusionsOnyx embolization could serve as a curative option for AVM treatment with accepted morbidity and mortality.

Endovascular Embolization of Ruptured Intracranial Arteriovenous Malformation: A Retrospective Analytic Study

“…Mohram et al (15) reported that modified Rankin Scale (mRS) ranged from 0 to 4, 9 patients (36.0%) had grade 0, 8 patients (32.0%) had grade 1, 4 patients (16.0%) had grade 2, 3 patients (12.0%) had grade 3 and one patient (4.0%) had grade 4. While Elewa (10) reported that regarding modified Rankin Scale, 16 patients (76.2%) were at grade 1, 4 patients (19.0%) were at grade 2, and 1 patient (4.8%) was at grade 3.…”

“…According to meta-analyses of extensive AVM case series, up to 7.4% of patients having microsurgery for AVM excision may experience serious side effects (9) . Endovascular embolization could serve as a curative option for AVM treatment with accepted morbidity and mortality (10) . Procedural safety was evaluated by assessing the periprocedural complications occurring within 1 month after embolization.…”

Early Outcomes and Complications of Endovascular Treatment of Cerebral Arteriovenous Malformations in Pediatric Patients

“…In our case series, we found an occlusion rate according to what has been reported. In this study, we assessed the obliteration rate immediately after the embolization; however, NBCA has shown a higher cure rate over time, which we were unable to assess [25].…”