Overview of the current concepts in the management of arteriovenous malformations of the brain

Unnithan, Aka

doi:10.1136/postgradmedj-2019-137202

Cited by 26 publications

(22 citation statements)

References 85 publications

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“…Cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) are congenital or acquired diseases characterized by arteriovenous shunt (AVS), which is a direct communication between the arterial and venous circulation without the capillary bed [1,2]. Patients with AVS carry certain risks of hemorrhagic complications [3,4].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography

et al. 2020

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Purpose Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including arteriovenous malformation (AVM) and arteriovenous fistula (AVF). However, this technique has the disadvantage of a relatively long scan time. The aim of this study was to compare diagnostic accuracy between compressed sensing (CS)-TOF and conventional parallel imaging (PI)-TOF-MRA for detecting and characterizing AVS. Methods This study was approved by the institutional review board for human studies. Participants comprised 56 patients who underwent both CS-TOF-MRA and PI-TOF-MRA on a 3-T MR unit with or without cerebral AVS between June 2016 and September 2018. Imaging parameters for both sequences were almost identical, except the acceleration factor of 3× for PI-TOF-MRA and 6.5× for CS-TOF-MRA, and the scan time of 5 min 19 s for PI-TOF-MRA and 2 min 26 s for CS-TOF-MRA. Two neuroradiologists assessed the accuracy of AVS detection on each sequence and analyzed AVS angioarchitecture. Concordance between CS-TOF, PI-TOF, and digital subtraction angiography was calculated using unweighted and weighted kappa statistics. Results Both CS-TOF-MRA and PI-TOF-MRA yielded excellent sensitivity and specificity for detecting intracranial AVS (reviewer 1, 97.3%, 94.7%; reviewer 2, 100%, 100%, respectively). Interrater agreement on the angioarchitectural features of intracranial AVS on CS-MRA and PI-MRA was moderate to good. Conclusion The diagnostic performance of CS-TOF-MRA is comparable to that of PI-TOF-MRA in detecting and classifying AVS with a reduced scan time under 2.5 min.

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Section: Introductionmentioning

confidence: 99%

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography

et al. 2020

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“…14 It provides an increased level of control during injection as well as more complete obliteration of AVMs as compared to glue embolization. 14 Additionally, the improved ease of use offered by EVOH has allowed for more types of cases to be treated endovascularly. 14 When embolization is pursued, liquid embolic agents including cyanoacrylate and ethylene vinyl alcohol generally are chosen, but particles and coils also can be considered.…”

Section: Discussionmentioning

confidence: 99%

“…The use of liquid embolization with EVOH in humans with brain AVMs has been well‐documented 14 . It provides an increased level of control during injection as well as more complete obliteration of AVMs as compared to glue embolization 14 . Additionally, the improved ease of use offered by EVOH has allowed for more types of cases to be treated endovascularly 14 …”

Section: Discussionmentioning

confidence: 99%

“…14 Additionally, the improved ease of use offered by EVOH has allowed for more types of cases to be treated endovascularly. 14 When embolization is pursued, liquid embolic agents including cyanoacrylate and ethylene vinyl alcohol generally are chosen, but particles and coils also can be considered. 5,15 Before the last 20 years, cyanoacrylate (particularly n-butyl cyanoacrylate) was the embolic liquid of choice.…”

Section: Discussionmentioning

confidence: 99%

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Ethylene vinyl alcohol copolymer to treat an intracranial arteriovenous malformation in a dog

Culp

Gratzek²,

Burtch

et al. 2021

Veterinary Internal Medicne

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A 6-year-old neutered male German shepherd dog was evaluated for obtundation, blindness, and bilateral exophthalmos. A magnetic resonance imaging scan of the brain was performed and identified an arteriovenous malformation (AVM) with several feeding arterial branches, and venous drainage through the cavernous sinus.Venous vessels rostral to the AVM were severely distended and extended into the retrobulbar spaces. Liquid embolization by injection of ethylene vinyl alcohol copolymer was performed from access points in the maxillary arteries and internal carotid arteries. No intraprocedural complications were encountered, and the dog was discharged the next day. Bilateral enucleation eventually was performed because of exposure keratopathy. At 31 months post-embolization, owners reported that the dog was doing very well clinically with high activity level and normal appetite, and the dog also appeared to be pain free. Although intracranial AVMs are very rare in companion animals, successful treatment using liquid embolization is possible and should be considered.

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“…It has also been observed that the AVM nidus is composed of haemodynamically independent compartments. 1 Exact knowledge about the nidus of an AVM and the connected vessels is very important in AVM embolization. 2 Haemodynamic AVM compartments can have one or more separate feeding arteries and one or more draining veins, and multiple compartments can share the same venous drainage.…”

Section: Introductionmentioning

confidence: 99%

Update Onyx embolization for plexiform arteriovenous malformation: Ante-grade drifting technique

Liang

2020

Neuroradiol J

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Objective The conventional arteriovenous malformation (AVM) Onyx embolization technique is the extrusion Onyx injection technique, with blood-flow control after a certain distance casting through the head end of the microcatheter. This method has elevated periprocedural AVM bleeding complications. In this study, the authors reported safety and efficacy of an updated ante-grade drifting Onyx injection for plexiform AVM embolization. Methods Between January 2016 and December 2018, 101 consecutive patients with plexiform AVMs were treated with ante-grade drifting Onyx injection. The patients’ clinical status was classified using the modified Rankin Scale (mRS). To measure associations, logistic univariate or multivariate regression analyses were used. Results Complete AVM obliteration was achieved in 51.2% (52/101) of patients. Two (2/101, 2.0%) arterial perforations occurred without causing neurological deficits. In univariate and multivariate logistic regression analyses, younger patient age (odds ratio (OR) = 1.06, 95% confidence interval (CI) 1.01–1.12, p = 0.014), haemorrhagic presentation at admission (OR = 7.14, 95% CI 1.52–33.33, p = 0.013) and low Spetzler–Martin grade (OR = 10.00, 95% CI 3.45–25.00, p < 0.001) were significantly correlated with complete obliteration. Pretreatment mRS was correlated with perforation complication (OR = 3.44, 95% CI 1.05–11.29, p = 0.041) in univariate logistic regression analysis but not in multivariate logistic regression analysis (OR = 2.956, 95%CI 0.745, 11.731, p = 0.123). Patients’ clinical status was significantly improved after endovascular AVM embolization. Conclusions With ante-grade drifting Onyx injection, it was possible to prevent serious bleeding complications and elevated complete embolization rate in plexiform AVMs. Younger patient age, haemorrhagic presentation at admission and low AVM Spetzler–Martin grade were significantly correlated with complete obliteration. Although there is not enough statistical power to show that the pretreatment mRS and the arterial perforation complication have a significant correlation, but its OR value is large, and there may be more data in the future to obtain further conclusion.

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Overview of the current concepts in the management of arteriovenous malformations of the brain

Cited by 26 publications

References 85 publications

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography

Ethylene vinyl alcohol copolymer to treat an intracranial arteriovenous malformation in a dog

Update Onyx embolization for plexiform arteriovenous malformation: Ante-grade drifting technique

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