Transvenous Curative Embolization of Cerebral Arteriovenous Malformations: A Prospective Cohort Study
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 w...
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Published in | Neurosurgery Vol. 83; no. 5; pp. 957 - 964 |
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Main Authors | , , , , , , |
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 | |
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Abstract | 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 |
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AbstractList | 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 Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). To assess contemporary outcomes of transvenous embolization as a stand-alone therapy for cerebral AVMs. 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. 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%. 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. 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 BACKGROUNDCurative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs).OBJECTIVETo assess contemporary outcomes of transvenous embolization as a stand-alone therapy for cerebral AVMs.METHODSWe 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.RESULTSThirty-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%.CONCLUSIONThis 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. 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 standalone 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 37.7yr (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 [+ or -] 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 KEYWORDS: Arteriovenous malformation, Curative therapy, Transvenous, Embolization |
Audience | Academic |
Author | Kalani, M Yashar S Iosif, Christina Lucena, Adson F Carvalho, Rui Saleme, Suzana Mounayer, Charbel Mendes, George A C |
AuthorAffiliation | Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah |
AuthorAffiliation_xml | – name: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah |
Author_xml | – sequence: 1 givenname: George A C surname: Mendes fullname: Mendes, George A C email: george_mendes@icloud.com organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France – sequence: 2 givenname: M Yashar S surname: Kalani fullname: Kalani, M Yashar S organization: Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah – sequence: 3 givenname: Christina surname: Iosif fullname: Iosif, Christina organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France – sequence: 4 givenname: Adson F surname: Lucena fullname: Lucena, Adson F organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France – sequence: 5 givenname: Rui surname: Carvalho fullname: Carvalho, Rui organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France – sequence: 6 givenname: Suzana surname: Saleme fullname: Saleme, Suzana organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France – sequence: 7 givenname: Charbel surname: Mounayer fullname: Mounayer, Charbel organization: Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France |
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Keywords | Embolization Arteriovenous malformation Curative therapy Transvenous |
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References | Kim (bib5-20231011) 2015; 76 Kessler (bib15-20231011) 2011; 69 Rutledge (bib8-20231011) 2014; 37 Bendok (bib1-20231011) 2014; 74 Luessenhop (bib19-20231011) 1960; 172 Consoli (bib23-20231011) 2013; 34 Bervini (bib7-20231011) 2014; 121 Han (bib6-20231011) 2003; 98 Crowley (bib11-20231011) 2014; 74 Baharvahdat (bib21-20231011) 2014; 35 Spetzler (bib4-20231011) 1986; 65 Van Rooij (bib13-20231011) 2007; 28 Crowley (bib2-20231011) 2014; 74 Massoud (bib22-20231011) 1999; 45 Mendes (bib17-20231011) 2016; 78 Mounayer (bib9-20231011) 2007; 28 Katsaridis (bib12-20231011) 2008; 50 Saatci (bib14-20231011) 2011; 115 Mendes (bib16-20231011) 2016; 78 Potts (bib20-20231011) 2014; 37 Mohr (bib3-20231011) 2014; 383 Kalani (bib10-20231011) 2013; 23 Iosif (bib18-20231011) 2015; 122 Sandoval-Garcia (bib24-20231011) 2016; 8 |
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malformations with transvenous Onyx embolization publication-title: Am J Neuroradiol doi: 10.3174/ajnr.A3497 contributor: fullname: Consoli – volume: 78 start-page: 458 issue: 3 year: 2016 ident: bib17-20231011 article-title: Transvenous embolization in pediatric plexiform arteriovenous malformations publication-title: Neurosurgery doi: 10.1227/NEU.0000000000001057 contributor: fullname: Mendes – volume: 172 start-page: 1153 issue: 11 year: 1960 ident: bib19-20231011 article-title: Artificial embolization of cerebral arteries. Report of use in a case of arteriovenous malformation publication-title: JAMA doi: 10.1001/jama.1960.63020110001009 contributor: fullname: Luessenhop – volume: 74 start-page: S60 issue: suppl 1 year: 2014 ident: bib1-20231011 article-title: Advances and innovations in brain arteriovenous malformation surgery publication-title: Neurosurgery doi: 10.1227/NEU.0000000000000230 contributor: fullname: Bendok – volume: 50 start-page: 589 issue: 7 year: 2008 ident: bib12-20231011 article-title: Curative embolization of cerebral arteriovenous malformations (AVMs) with Onyx in 101 patients publication-title: Neuroradiology doi: 10.1007/s00234-008-0382-x contributor: fullname: Katsaridis – volume: 28 start-page: 172 issue: 1 year: 2007 ident: bib13-20231011 article-title: Brain AVM embolization with Onyx publication-title: AJNR Am J Neuroradiol contributor: fullname: Van Rooij – volume: 115 start-page: 78 issue: 1 year: 2011 ident: bib14-20231011 article-title: Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: long-term results in 350 consecutive patients with completed endovascular treatment course publication-title: J Neurosurg doi: 10.3171/2011.2.JNS09830 contributor: fullname: Saatci |
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Snippet | Abstract
BACKGROUND
Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs).
OBJECTIVE
To assess... Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). To assess contemporary outcomes of... BACKGROUND: Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). OBJECTIVE: To assess... BACKGROUND Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). OBJECTIVE To assess... BACKGROUNDCurative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs).OBJECTIVETo assess... |
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SubjectTerms | 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 |
Title | Transvenous Curative Embolization of Cerebral Arteriovenous Malformations: A Prospective Cohort Study |
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