Transvenous Curative Embolization of Cerebral Arteriovenous Malformations: A Prospective Cohort Study

• Published in: Neurosurgery Vol. 83; no. 5; pp. 957 - 964
• Main Authors: Mendes, George A C, Kalani, M Yashar S, Iosif, Christina, Lucena, Adson F, Carvalho, Rui, Saleme, Suzana, Mounayer, Charbel
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.11.2018; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc; Lippincott, Williams & Wilkins
• Subjects: Arteriovenous malformations; Care and treatment; Cohort analysis; Embolization; Health aspects; Ireland; Life Sciences; Medical equipment and supplies industry; Medical test kit industry; Mortality; Neurosurgery; Patients; Ireland; Embolization; Arteriovenous malformation; Curative therapy; Transvenous
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyx581

Abstract BACKGROUND Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). OBJECTIVE To assess contemporary outcomes of transvenous embolization as a stand-alone therapy for cerebral AVMs METHODS We prospectively followed 40 patients with 41 AVMs who underwent transvenous endovascular therapy between January 2008 and January 2015. Patient demographics, AVM characteristics, endovascular techniques used, angiographic results, clinical outcomes, and complications were assessed independently. RESULTS Thirty-eight of 41 (92.6%) AVMs were anatomically cured. The mean patient age was 37.7 yr (range, 18-69 yr) and 55% were female. Twenty-seven (67.5%) patients presented with hemorrhage. The mean size of the AVM nidus was 2.8 ± 1.2 cm, and low Spetzler-Martin grade AVMs comprised 41.5% of lesions. The majority of patients were treated in 1 session (56%; n = 23). The mean follow-up period was 28.4 (range, 6-106 mo). There was 1 (2.5%) hemorrhagic complication related to microcatheter navigation and 1 (2.5%) venous infarction was observed without clinical consequences. At 6-mo follow-up, 1 (2.5%) patient had significant disability. There were no recurrences during the follow-up period. Overall mortality was 2.5% and procedure-related mortality was 0%. CONCLUSION This prospective contemporary series demonstrates a high rate of complete AVM obliteration and excellent functional outcomes in patients with both ruptured and unruptured AVMs treated with transvenous embolization. This approach is promising and warrants further investigation as a treatment for select AVMs