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Interv Neuroradiol. 2016 Aug;22(4):445-51. doi: 10.1177/1591019916641316. Epub 2016 Apr 11.

Less can be more: Targeted embolization of aneurysms associated with arteriovenous malformations unsuitable for surgical resection.

Author information

1
Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, USA matthew.alexander@ucsf.edu.
2
Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, USA.
3
Department of Radiology, University of Washington, USA.
4
Department of Anesthesia and Perioperative Care, University of California San Francisco, USA.

Abstract

INTRODUCTION:

To mitigate risks of hemorrhage, high-risk features of brain arteriovenous malformations (BAVMs) can be targeted to reduce the risk of rupture. Previous investigation has examined embolization of a pedicle supplying a high-risk feature; this study examines embolization targeted specifically at aneurysms associated with BAVMs.

MATERIALS AND METHODS:

Patients with BAVMs treated at two high-volume neurointerventional services were retrospectively reviewed. Patients treated with intention to occlude only the associated aneurysm itself were analyzed. Demographic and lesion characteristics were identified, as were technical and clinical outcomes. Adverse events were defined as hemorrhage, new seizure, and death.

RESULTS:

Thirty-two patients met inclusion criteria out of 1103 patients treated during the study period. Twenty-seven (84.4%) BAVMs were acutely ruptured, all with the aneurysm identified as the hemorrhage source. Twenty-four (75.0%) lesions involved eloquent territory. There were equal numbers of feeding artery and nidus aneurysms. Follow-up data were available for a total of 101.3 patient-years for a mean follow-up time of 2.9 years. One patient died; the remaining 31 patients had improved functional status at last contact. Annualized rate of hemorrhage after treatment was 1.0%; rate of adverse events after treatment was 3.0%. Excluding time after confirmed occlusion following radiosurgery, annualized rates were 1.4% and 4.8%, respectively.

CONCLUSION:

In inoperable BAVMs, targeted embolization of associated aneurysms can be performed safely and effectively. This should be considered in high-risk lesions prior to radiosurgery or in cases when no other treatment options are available. Such intervention warrants further investigation.

KEYWORDS:

Arteriovenous malformation; aneurysm; embolization; intracranial hemorrhage

PMID:
27066813
PMCID:
PMC4984389
DOI:
10.1177/1591019916641316
[Indexed for MEDLINE]
Free PMC Article

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