Curative Transvenous Embolization for Ruptured Brain Arteriovenous Malformations: A Single-Center Experience from China

World Neurosurg. 2018 Aug;116:e421-e428. doi: 10.1016/j.wneu.2018.04.223. Epub 2018 May 9.

Abstract

Objective: To evaluate feasibility and safety of transvenous embolization for brain arteriovenous malformations (AVMs).

Methods: Between November 2016 and August 2017, a transvenous endovascular embolization protocol was implemented at the Henan Provincial People's Hospital for consecutive patients with ruptured brain AVMs. Therapeutic decision making was based on Spetzler-Martin grade, brain AVM location, pattern of venous drainage, and angioarchitecture. Transvenous embolization was combined with transarterial support. Complete angiographic obliteration of the nidus was the objective of treatment.

Results: Among 10 patients with ruptured brain AVMs, 8 were male. Spetzler-Martin grades before transvenous embolization were IV in 3 patients, III in 5 patients, II in 1 patient, and I in 1 patient. Modified Rankin Scale score before the procedure was 0-2 for 6 of 10 patients. Five patients also had deep venous drainage. Arterial blood pressure control and venous pressure cooker technique were used in all 10 patients; 9 patients had immediate angiographic occlusion. Two patients had a ventricular hemorrhage, which did not cause any disability after medical treatment. Seven patients underwent angiography 3-5 months after the procedure, and complete obliteration of the nidus was confirmed. Median clinical follow-up for all 10 patients was 8 months (range, 3-12 months). Epilepsy occurred in 1 patient 3 months after the procedure, and modified Rankin Scale scores for all patients were ≤1.

Conclusions: Transvenous embolization of brain AVMs is feasible and may improve cure rates. The safety and long-term effects need further validation.

Keywords: Brain arteriovenous malformation; Embolization; Internal jugular vein approach.

MeSH terms

  • Adolescent
  • Adult
  • Arteriovenous Fistula / diagnostic imaging*
  • Arteriovenous Fistula / epidemiology
  • Arteriovenous Fistula / therapy*
  • Cerebral Veins / diagnostic imaging*
  • Child
  • China / epidemiology
  • Drug Combinations
  • Embolization, Therapeutic / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / epidemiology
  • Intracranial Arteriovenous Malformations / therapy*
  • Male
  • Middle Aged
  • Polyvinyls / administration & dosage
  • Tantalum / administration & dosage
  • Treatment Outcome
  • Young Adult

Substances

  • Drug Combinations
  • Onyx 18
  • Polyvinyls
  • Tantalum