Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

Abstract

BACKGROUND AND PURPOSE: The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs. MATERIALS AND METHODS: Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes. RESULTS: Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21). CONCLUSIONS: Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment. B rain arteriovenous malformations are characterized by an intervening plexus of abnormal vessels (nidus) between feeding arteries and draining veins. The most common presentations of AVMs include hemorrhages, seizures, headaches, and

Perioperative Complications of Transvenous Embolization of Ruptured Intracranial Arteriovenous Malformations

“…Although trepanation and drainage, lumbar cistern drainage, and symptomatic treatment were performed, the patient's symptoms did not improve. The other case, which had been described in the previous studie ( 6 ), was in a shallow coma state on day 1 postoperatively (case 7), and cranial MRI showed cerebral edema and acute cerebral infarction in the left thalamus, which might be caused by the use of anhydrous ethanol embolization agent. The patient was administered conservative drug treatment and presented mRS score of 5 at discharge.…”

Transvenous retrograde embolization of ruptured brain arteriovenous malformations: A case report and review of the literature

“…In recent years there have been individual case reports [7 , 8] as well as series of cases [5 , [9] , [10] , [11] showing that this technique gives promising results, high rate of embolism, less technical complications. However, the number of cases is still small, and the effectiveness and safety are still unknown.…”

“…Currently, indications for interventional treatment of AVMs through transvenous routes include AVMs located in deep locations with a high risk of surgical complications, small nidus size (less than 3cm in greatest diameter), unfavorable arterial access, a single draining vein, and ruptured AVMs [5 , 6] . In particular, the prognostic ability must completely occlude the malformation according to an “all-or-nothing” technique, otherwise, the risk of bleeding is very high due to active obstruction of the draining vein.…”

Experimental investigation of transvenous embolization of arteriovenous malformations using different in vivo models

“…This new technique is often performed after or in combination with TAE, but can also be performed alone as the primary treatment technique 6 18. The few clinical studies on this technique achieved relatively high occlusion rates, concentrating around 90%, while the complication rates were similar to those with conventional TAE 6 18–20. These occlusion rates are higher than the occlusion rates reported for TAE 1–5.…”