Target Embolization of Associated Aneurysms in Ruptured Arteriovenous Malformations

World Neurosurg. 2017 May;101:26-32. doi: 10.1016/j.wneu.2017.01.081. Epub 2017 Jan 31.

Abstract

Objectives: The purpose of this study was to examine the safety and efficacy of target embolization of aneurysms associated with ruptured brain arteriovenous malformations (BAVMs).

Methods: Ruptured BAVM patients who underwent endovascular treatment at our institution from January 2011 to December 2015 were retrospectively reviewed. Patients were divided into aneurysm (AN) and nonaneurysm (non-AN) groups on the basis of the existence of BAVM-associated aneurysms or not. Demographics, angiographic characteristics, complications, and clinical outcomes were compared between 2 groups. Complication risk factors were analyzed for all objects. Patient outcomes were assessed with modified Rankin Scale (mRS).

Results: A total of 129 (male = 53) patients were included. In 31 (24.0%) patients, 33 aneurysms were observed, including 16 intranidal and 17 flow-related aneurysms. Of the 166 sessions of embolization performed, there were 13 (10.1% of patients, 7.8% per session) complications in all, including 2 hemorrhagic, 8 transient ischemic, and 3 permanent ischemic types. There was no statistical difference in terms of complication incidence rate between groups. A total of 12 patients (9.3% of patients, 3.3% per person-year) experienced postoperative hemorrhage during follow-up (mean = 3.4 years). The yearly postoperative hemorrhage incidence rate was 3.4% in the non-AN group and 2.0% in AN group. Excellent or good outcomes (mRS ≤ 2) were observed in 103 (91.2%) patients. Unfavorable outcomes (mRS ≥ 3) as a direct result of embolization remained in no patients.

Conclusions: Target embolization of aneurysms associated with ruptured BAVMs could significantly decrease postoperative rehemorrhage without increasing complications.

Keywords: Associated aneurysm; Complication; Rehemorrhage; Ruptured brain arteriovenous malformations; Target embolization.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / surgery
  • Child
  • Child, Preschool
  • Computed Tomography Angiography
  • Drug Combinations
  • Embolization, Therapeutic / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Intracranial Aneurysm / etiology*
  • Intracranial Aneurysm / surgery*
  • Intracranial Arteriovenous Malformations / surgery*
  • Logistic Models
  • Male
  • Middle Aged
  • Polyvinyls / therapeutic use
  • Postoperative Complications / etiology*
  • Postoperative Complications / surgery*
  • Retrospective Studies
  • Risk Factors
  • Tantalum / therapeutic use
  • Young Adult

Substances

  • Drug Combinations
  • Onyx 18
  • Polyvinyls
  • Tantalum