Endovascular Treatment Accounts for a Change in Brain Arteriovenous Malformation Natural History Risk

Abstract

<jats:p> This study estimated the risk and rates of intracranial hemorrhage (ICH) in patients harboring brain arteriovenous malformation (BAVM) after endovascular embolization. One hundred and forty-four consecutive patients with BAVM treated with endovascular embolization between 1998 and 2003 were retrospectively reviewed. The risk of ICH subsequent to endovascular embolization was studied using Kaplan-Meier curves. </jats:p><jats:p> We reviewed 144 patients with BAVM treated with endovascular embolization. Two hundred and sixty-nine procedures were performed, 69 were performed with silk sutures, 18 with coils, 137 with NBCA and 36 with Onyx18. Twenty-three (16.0%) patients were treated with additional gamma-knife radiosurgery and one (0.7%) with additional surgical AVM excision. Complete obliteration of BAVMs was achieved in 20 patients (13.9%). During a mean follow-up of 5.9 years for the ICH group and 6.9 years for the non-ICH group, hemorrhages occurred in 11 (17.7%) of the ICH patients and in nine (11%) of the non-ICH group (p&gt;0.1). The annual risk of hemorrhage was 3.0% and 1.6%, respectively. In the multivariate regression model, the adjusted relative risk (RR) for hemorrhage at initial presentation was 1.6 (95% CI 1.2–3.2; p&gt;0.1). Deep venous drainage, male sex, age or AVM size were not significantly associated with subsequent hemorrhage. ICH and non-ICH groups did not differ in progression to subsequent ICH after endovascular embolization (log-rank X<jats:sup>2</jats:sup> = 1.339, p&gt;0.1) in survival analyses. The overall annual hemorrhage risk for all patients after endovascular embolization was 2.1%. </jats:p><jats:p> Endovascular embolization alone or combined with gamma-knife radiosurgery or surgical treatment are able to decrease ICH occurrence compared to abstention. </jats:p>

Arteriovenous Malformation in the Brain: A Theoretical Study Explaining the Behavior of Liquid Embolic Agents during Endovascular Treatment

“…In three dimensions, Eq. (3) can be generalized to (6) where the permeability k is a general secondorder tensor. The terms v and ∇p are Darcy conditions and filled the directly dependent nidus compartment antegradely and later retrogradely until it flowed to the tip of the microcatheter.…”

The clinical characteristics and treatment of cerebral AVM in pregnancy

“…Preoperative intravascular embolization may reduce the risk of bleeding in surgery, but endovascular embolization likely cause ischemic or hemorrhagic complications. 16,17 If the fetus is mature, hemorrhagic AVM should be resected at early postpartum. 14 Robinson et al reported that mothers with hemorrhagic AVM were treated by neurosurgical operations, in which there were no mother deaths, 26% fetal mortality, and maternal mortality was 10% in a conservative treatment group.…”

The clinical characteristics and treatment of cerebral AVM in pregnancy

“…Preoperative intravascular embolization may reduce the risk of bleeding in surgery, but endovascular embolization is likely to cause ischemic or hemorrhagic complications. 16,17 If the fetus is mature, a hemorrhagic AVM should be resected at an early stage postpartum. 14 Robinson et al reported that when mothers with hemorrhagic AVM were treated by neurosurgical operation, there were no deaths among the mothers, fetal mortality was 26%, and maternal mortality was 10% in a conservative treatment group.…”