Delayed Parenchymal Hemorrhage Following Successful Embolization of Brainstem Arteriovenous Malformation  -Case Report-

Morihiro, Yusuke; Harada, Kei; Kato, Shoichi; Ishihara, Hideyuki; Shirao, Satoshi; Nakayama, Hiromichi; Akimura, Tatsuo; Suzuki, Michiyasu

doi:10.2176/nmc.50.661

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…In addition to increasing the visibility of NBCA, changing the NBCALipiodol mixing ratio also affects the polymerization time [69,122,124,148,154]. A short polymerization time, i.e., using a small amount of Lipiodol, is suitable for occluding short blood vessel segments.…”

Section: (4) Tungsten Powdermentioning

confidence: 99%

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

et al. 2014

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Section: (4) Tungsten Powdermentioning

confidence: 99%

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

et al. 2014

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“…This treatment may carry its own risk of periprocedural hemorrhage, and also of delayed hemorrhage because of continued blood inflow into a nidus with impaired outflow. 14,15 In our series, 2.6% of nonhemorragic AVMs bled in the time between diagnosis and RS. Embolization had a hazard ratio of 2.793 for postradiosurgical bleeding rates; however, this number was not significant.…”

Section: Discussion Postradiosurgical Bleeding Risk Of Hemorrhagic Anmentioning

confidence: 58%

Postradiosurgery Hemorrhage Rates of Arteriovenous Malformations of the Brain

Parkhutik

Lago

Tembl

et al. 2012

Stroke

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Background and Purpose-The long-term benefit of radiosurgery of brain arteriovenous malformations (AVM), especially nonhemorrhagic cases, is controversial. We calculated hemorrhage rates pre-and posttreatment and analyzed the risk factors for bleeding based on cases followed at our site. Methods-One hundred eight patients, age 36Ϯ17 years, 56 men. The mean follow-up was 65Ϯ44 months (median, 54; interquartile range, 33-94). Most AVMs were small (74.1% Ͻ3 cm in diameter); 48.1% were located in an eloquent area, 27.8% had deep drainage, and 39.8% presented with hemorrhage. Results-The annual hemorrhage rate for any undiagnosed AVM was 1.2%, and 3.3% for AVMs with hemorrhagic presentation. Older patients, cortical or subcortical AVMs, and cases with multiple draining veins were less likely to present with bleeding. During the first 36 months postradiosurgery, hemorrhagic AVMs had a rebleeding rate of 2.1%, and a rate of 1.1% from 3 years onwards. Nonhemorrhagic AVMs had a hemorrhage rate of 1.4% during the first 3 years and 0.3% afterward. Arterial hypertension and nidus volume were independent predictors of bleeding after treatment. Mean nidus obliteration time was 37Ϯ18 months (median, 32; interquartile range, 25-40), with hemorrhage rate of 1.3% before and 0.6% after obliteration, and 1.9% for AVMs that were not closed at the end of follow-up. Conclusions-Both hemorrhagic and nonhemorrhagic AVMs benefit from radiosurgical therapy, with gradual decrease in their bleeding rates over the years. Albeit small, the risk of hemorrhage persists during the entirety of follow-up, being higher for cases with hemorrhagic presentation and nonobliterated AVM. (Stroke. 2012;43:1247-1252.)

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Intra- and post-operative acute hemorrhagic complications of Onyx embolization of brain arteriovenous malformations: A single-center experience

Chen

Wang

2022

Front. Neurol.

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BackgroundThe intra- and post-operative acute (within 72 h) hemorrhagic complications of endovascular treatment (EVT) for a brain arteriovenous malformation (BAVM) are disastrous. Thus, further experiential summaries are required to fully understand them.Materials and methodsThis was a retrospective study of 25 patients with consecutive BAVM who were treated via EVT with Onyx embolization and suffered intra- and post-operative acute hemorrhage. The clinical and imaging data of the patients were recorded, analyzed, and discussed.ResultTwenty-five patients were aged 11–70 years (mean, 37.2 ± 16.1 years), of whom 12 were female (48%, 12/25). Of the 25 hemorrhagic complications, 17 (68%, 17/25) were intraoperative, and 8 (32%, 8/25) were post-operative and occurred between 1 and 12 h after EVT. Of 17 intraoperative hemorrhages, 13 (76.5%, 13/17) were due to high-pressure Onyx casting. Of eight post-operative hemorrhages, six (75%, 6/8) were attributed to normal perfusion pressure breakthrough. The degree of nidus Onyx embolization was more than 2/3 or complete in seven (87.5%, 7/8) BAVMs. Draining vein occlusion was observed in eight (32%, 8/25) of 25 BAVMs. After hemorrhage, conservative treatment was administered in 12 (48%, 12/25) cases, and surgical management was performed in other cases. There were eight cases of mortality; the remaining 17 patients had follow-up data. Among them, 15 patients had good outcomes, with Glasgow Outcome Scale scores of 5 and 4, accounting for 60% (15/25).ConclusionIn EVT for BAVMs, intra- and post-operative acute hemorrhagic complications are disastrous; only 60% of patients have a good outcome. Therefore, high-pressure Onyx casting or casting too much Onyx at one time to pursue a high degree of nidus embolization should be performed cautiously, and primary draining vein occlusion should be avoided. In short, EVT needs to be performed carefully.

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Delayed Parenchymal Hemorrhage Following Successful Embolization of Brainstem Arteriovenous Malformation -Case Report-

Cited by 3 publications

References 11 publications

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

Postradiosurgery Hemorrhage Rates of Arteriovenous Malformations of the Brain

Intra- and post-operative acute hemorrhagic complications of Onyx embolization of brain arteriovenous malformations: A single-center experience

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