Antithrombotic therapy and intracranial bleeding in subjects with sporadic brain arteriovenous malformations: preliminary results from a retrospective study

Background/Objective: Compliant dual-lumen balloon microcatheters have been used to perform balloon-assisted embolization (BAE) of brain arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (Onyx). However, vessel rupture and microcatheter retention have been reported from BAE using these microcatheters. Using an extra-compliant balloon microcatheter (Scepter XC; Microvention, Tustin, CA, USA) could help avoid pial vessel rupture during BAE. We herein report our experience using this balloon microcatheter for BAE. Methods: This retrospective study included patients who underwent BAE of brain AVMs at our institution between June 2012 and March 2017. Results: The extra-compliant Scepter XC balloon microcatheter was used for BAE of brain AVMs in 23 patients aged 44.3 ± 16.7 years (range 0–65 years). A total of 40 intracranial vessels (39 pial arteries and 1 pial vein) were catheterized and embolized during 30 separate sessions. In all instances, the balloon microcatheter could be successfully advanced to the AVM nidus. A mean volume of 2.4 ± 1.7 mL (range 0.65–4.6 mL) of Onyx was injected per session. There were no instances of vessel rupture, microcatheter retention, or stroke. Conclusion: Utilization of the extra-compliant balloon microcatheter results in safe and effective BAE, which adds to the growing experience with BAE for AVM treatment.

Download Full-text

Endovascular Treatment of Brain Arteriovenous Malformations Using Onyx: Preliminary Results of a Prospective Multicenter Study

Interventional Neuroradiology ◽

10.1177/15910199050110s119 ◽

2005 ◽

Vol 11 (1_suppl) ◽

pp. 159-164 ◽

Cited By ~ 40

Author(s):

L. Pierot ◽

A. C. Januel ◽

D. Herbreteau ◽

X. Barreau ◽

J. Drouineau ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Clinical Value ◽

Multicentric Study ◽

Ethylene Vinyl Alcohol ◽

Complete Occlusion ◽

Preliminary Results ◽

Liquid Polymer ◽

Brain Arteriovenous Malformations ◽

Permanent Occlusion ◽

Brain Avms

The main final goal of the treatment of brain AVMs is to prevent bleeding and to obtain a complete occlusion of the nidus. The strategy of treatment of brain arteriovenous malformations (AVM) has to be defined by a multidisciplinary team and will usually combine several modalities (surgery, radiosurgery, embolization). Embolization is generally the first step of treatment. Occasionally embolization is able to completely occlude a small AVM. Otherwise embolization is the first step before surgery or radiosurgery. Several embolic agents have been proposed for embolization of brain AVMs like particles or cyanoacrylates. The main disadvantage of particles is the high frequency of recanalization. The cyanoacrylates are probably more appropriate, providing a permanent occlusion. However, due to the polymerizing characteristics of the glue, the time of injection is relatively short (few seconds or minutes) and a complete or substantial occlusion of the nidus is difficult to obtain, especially in the case of medium or largesized AVMs. Onyx is a nonadhesive liquid polymer made of a mixture of ethylene-vinyl-alcohol copolymer and dimethylsulfoxide. The theoretical advantage of a nonadhesive liquid is to eliminate the risk of gluing the microcatheter and subsequently to perform a more durable injection with a larger amounts of agent delivered in a single injection. Several French centers have undertaken a prospective, multicentric study to evaluate the clinical value of Onyx in embolization of brain AVMs. As required, 50 patients were included. Preliminary results are presented regarding the first 48 patients, the last 2 patients being included after writing of this paper. The treatment is now completed in 15 patients. As expected, it was possible with Onyx to perform long duration injections (5 to 70 minutes with a mean of 34 minutes). Volumes injected per session were also important (0.25 to 6 ml with a mean of 1.6 ml). According to the clinical experience of the centers, duration and volume injected were most important with Onyx than with cyanoacrylates. Out of the 15 patients for whom embolization is now completed, 14 had a percentage of occlusion of the nidus greater than 60% (with 2 complete occlusion).

Download Full-text

Results of surgical treatment of unruptured brain arteriovenous malformations – monocentric retrospective study

Česká a slovenská neurologie a neurochirurgie ◽

10.14735/amcsnn2018298 ◽

2018 ◽

Vol 81/114 (3) ◽

pp. 298-303

Author(s):

Martin Bolcha ◽

Martin Sameš

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Arteriovenous Malformations ◽

Brain Arteriovenous Malformations

Download Full-text

Interval angioarchitectural evolution of brain arteriovenous malformations following rupture

Journal of Neurosurgery ◽

10.3171/2018.2.jns18128 ◽

2019 ◽

Vol 131 (1) ◽

pp. 96-103 ◽

Cited By ~ 1

Author(s):

Hengwei Jin ◽

Stephanie Lenck ◽

Timo Krings ◽

Ronit Agid ◽

Yibin Fang ◽

...

Keyword(s):

Retrospective Study ◽

Digital Subtraction Angiography ◽

Arteriovenous Malformations ◽

Demographic Data ◽

Digital Subtraction ◽

Spontaneous Thrombosis ◽

Factors Associated ◽

Brain Arteriovenous Malformations ◽

Delayed Phase

OBJECTIVEThe goal of this study was to describe changes in the angioarchitecture of brain arteriovenous malformations (bAVMs) between acute and delayed cerebral digital subtraction angiography (DSA) obtained after hemorrhage, and to examine bAVM characteristics predicting change.METHODSThis is a retrospective study of a prospective institutional bAVM database. The authors included all patients with ruptured bAVMs who had DSA in both acute and delayed phases, with no interval treatment of their bAVM, between January 2000 and April 2017. The authors evaluated the existence or absence of angioarchitectural changes. Demographic data, radiological characteristics of hemorrhages, and angioarchitectural features of the bAVMs of the two patients’ groups were analyzed. Univariate and multivariate logistic analyses were performed to identify predictors of angioarchitectural change.RESULTSA total of 42 patients were included in the series. Seventeen (40.5%) patients had angioarchitectural changes including bAVM only visible on the delayed DSA study (n = 8), spontaneous thrombosis of the AVM (n = 3), or alteration of the size or the opacification of the nidus (n = 6). The factors associated with angioarchitectural changes were a small nidus (3.8 ± 7.9 ml vs 6.1 ± 9.5 ml, p = 0.046), a superficial location (94.1% vs 5.9%, p = 0.016), and a single superficial draining vein (58.8% vs 24.0%, p = 0.029).CONCLUSIONSAngioarchitectural changes can be seen in 40% of ruptured bAVMs between the acute- and delayed-phase DSA. A small nidus, a superficial location, and a single superficial draining vein were statistically associated with the occurrence of angioarchitectural changes. These changes included either enlargement or spontaneous occlusion of the bAVM, as well as subsequent diagnosis of a bAVM following an initial negative DSA study.

Download Full-text