Selective arterial temporary flow arrest with balloons during transvenous embolization for the treatment of brain arteriovenous malformations: a feasibility study with MRI-monitored adverse events

BackgroundThe technique of endovascular transvenous embolization for brain arteriovenous malformations (AVMs) has emerged in the last 8 years as a very promising therapeutic alternative for otherwise incurable cases. Selective temporary flow arrest during transvenous endovascular embolization (TFATVE) is a novel adaptation of our previously described transvenous approach, which employs hyper-compliant balloons intra-arterially for the selective occlusion of arterial feeders during ethylene vinyl copolymer (EVOH) injection, in order to reduce intra-nidal pressure and increase nidi occlusion rates.MethodsWe performed a feasibility study of the TFATVE technique between January 2016 and April 2020. Consecutive patients were included. All patients had at least one axial brain MRI or CT in the first 48 hours following intervention, and at least one brain MRI scan within the first postoperative month, in order to detect both silent and clinically evident adverse events. Patients’ demographics, angio-architectural characteristics, total injection and procedure times, angiographic and clinical outcomes were analyzed.Results22 patients underwent TFATVE during transvenous endovascular treatment of brain AVMs. Among them, 86.4% were high Spetzler-Martin’s grade. Good clinical outcome (modified Rankin Scale <2) was achieved in 95.5% of the cases, with 0% of procedure-related mortality and 4.5% of clinically significant, procedure-related morbidity. Total occlusion of the nidus was achieved in >90% of the cases at the end of the procedure and angiographic stability was achieved in all cases; 100% of the cases had angiographic cure at follow-up.ConclusionsTFATVE seems a safe and effective technique when conducted in carefully selected patients in highly specialized centers.

ARTERIOVENOUS MALFORMATIONS OF THE BRAIN: ACHIEVEMENTS, ANALYSIS OF DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT IN THE CONDITIONS OF THE REPUBLICAN RESEARCH CENTER OF EMERGENCY MEDICAL CARE (20-YEAR OF THE CLINIC EXPERIENCE)

Aim. To assess the results of the activities of the neurosurgical service of the Republican Research Center of Emergency Medicine (RRCEM) over a twenty-year period of operation with an analysis of the results of neurosurgical care for patients with arteriovenous malformations of the brain (AVM). Material and Methods. The analysis was carried out of 54 patients examined and operated on for AVM, in the period from 2001 to 2020, who were treated at the Department of Adult Neurosurgery of the RRCEM. Results. The basis of our principle of a differentiated surgical approach in the treatment of AVM is the determination of the AVM grading according to the Spetzler-Martin and Lawton-Young scales. Limiting only microsurgical AVM resection is advisable for AVMs – I and II grades according to the Spetzler-Martin and Lawton-Young scales. For patients with high grades of AVMs – grade III and more, it is more expedient to use a combined technique, and with deeply located AVMs, endovascular embolization.