Authors: Lv, Xianli; Wu, Zhongxue; Li, Youxiang; Yang, Xinjian; Jiang, Chuhan

Source: Neurological Research, Volume 34, Number 6, July 2012 , pp. 552-556(5)

Publisher: Maney Publishing

Abstract:

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.

Keywords: Arteriovenous malformations; Cerebral hemorrhage; Embolization

Document Type: Original Article

DOI: http://dx.doi.org/10.1179/1743132812Y.0000000044

Affiliations: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China

Publication date: 2012-07-01

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