Hemorrhage risk after partial endovascular NBCA and ONYX embolization for brain arteriovenous malformation

Neurol Res. 2012 Jul;34(6):552-6. doi: 10.1179/1743132812Y.0000000044. Epub 2012 May 30.


Objective: To estimate for hemorrhage risk of partially endovascularly embolized brain arteriovenous malformation (BAVM).

Methods: We retrospectively reviewed 147 consecutive patients with BAVM-treated mainly with endovascular N-butyl cyanoacrylate (NBCA) and ONYX embolization. In Kaplan-Meier survival analysis, the index date was the dated of initial endovascular embolization; cases were censored at time of subsequent intracranial hemorrhage (ICH), or loss to follow-up, and multivariate proportional-hazards regression models included age of presentation (≤30 years old), clinical presentations, and other potential confounders.

Results: We reviewed 147 patients with BAVM (58.8% male; mean age±SD at treatment: 27.5±11.1 years) treated with endovascular embolization. One hundred and forty-four NBCA and 76 ONYX embolizations were performed. Complete obliteration of BAVMs was achieved in 29 patients (19.7%). Thirty-two (21.8%) patients were treated with additional Gamma-knife radiosurgery. During 499.5 years of follow-up, 15 partially treated patients suffered a further hemorrhage, which caused four deaths. The crude annual risk of hemorrhage was 3.0% and the annual death rate was 0.8%. Among partially treated patients with hemorrhage at initial presentation, the risk of hemorrhage was 3.8%, while the risk of hemorrhage for patients without hemorrhage at initial presentation was 2.5%. The annual rate of subsequent hemorrhage was 2.6% for non-ICH and 4.2% for ICH in the partial NBCA embolization group compared with 2.4% for non-ICH and 2.4% for ICH in the partial ONYX embolization group.

Conclusions: The effect of partial AVM embolization with liquid embolic agents may still be unclear as for risk reduction of annual hemorrhage rate of cerebral AVM.

MeSH terms

  • Adult
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / mortality
  • Arteriovenous Fistula / therapy*
  • Dimethyl Sulfoxide / therapeutic use
  • Embolization, Therapeutic / methods*
  • Enbucrilate / therapeutic use
  • Endovascular Procedures
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / complications
  • Intracranial Arteriovenous Malformations / mortality
  • Intracranial Arteriovenous Malformations / therapy*
  • Intracranial Hemorrhages / epidemiology*
  • Intracranial Hemorrhages / etiology
  • Intracranial Hemorrhages / prevention & control*
  • Kaplan-Meier Estimate
  • Male
  • Polyvinyls / therapeutic use
  • Retrospective Studies
  • Risk Factors


  • Onyx copolymer
  • Polyvinyls
  • Enbucrilate
  • Dimethyl Sulfoxide