Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Abstract

Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

Case report: Onyx embolization of tentorial dural arteriovenous fistula via the meningohypophyseal trunk and medial tentorial artery of Bernasconi-Cassinari

“…In case 1, after finishing Onyx embolization, the Marathon microcatheter can be easily removed without difficulty, which was suggested in our previous reports (26,27). When removing the Marathon microcatheter, backing mass coils toward the ICA should be considered.…”

Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

“…Arteriovenous shunt diseases, including BAVM, DAVF, PAVF or vein of Galen aneurysmal malformations, can result in blood flow overload (Figures 2G,H) (12,(14)(15)(16)(56)(57)(58)(59)(60). These aneurysms are often located at the proximal PCA (61).…”

“…Obliteration of the aneurysm prior to treating these arteriovenous shunts is preferred (12). In BAVMs, the increased pressure in the feeding artery following EVT can contribute to aneurysm rupture (94,95).…”

“…A fusiform aneurysm shape can be found in up to 25% of all PCA trunk aneurysms (10). PCA trunk aneurysms can occur in isolation or in association with brain arteriovenous malformation (BAVM), dural or pial arteriovenous fistula (DAVF or PAVF), vein of Galen aneurysmal malformation, internal carotid artery (ICA) occlusion, and moyamoya disease (MMD) (11)(12)(13)(14)(15)(16).…”

Arteriovenous Malformations—Current Understanding of the Pathogenesis with Implications for Treatment

“…For pediatric patients, reduction of the radiation dose and contrast media should be considered. However, catheter angiography remains a prerequisite for treatment of AVMs [56,57].…”