Erschienen in:
13.05.2022 | Original Article
Safety and Effectiveness of First-line Endovascular Management of Low-Grade Brain Arteriovenous Malformations
Single Center Experience in 145 Patients
verfasst von:
Maichael Talaat, Eimad Shotar, Kévin Premat, Anne-Laure Boch, Mariette Delaitre, Pierre-Yves Borius, Aurelien Nouet, Stéphanie Lenck, Atika Talbi, Awad Bessar, Mohammed Taema, Ahmed Bessar, Farouk Hassan, Tamer S. Elserafy, Etienne Lefevre, Vincent Degos, Nader Sourour, Frédéric Clarençon
Erschienen in:
Clinical Neuroradiology
|
Ausgabe 4/2022
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Abstract
Purpose
Spetzler-Martin grade (SMG) I–II (low-grade) brain arteriovenous malformations (BAVMs) are often considered safe for microsurgical resection; however, the role of endovascular treatment (EVT) remains to be clarified in this indication, especially for unruptured BAVMs. The purpose of our study was to assess the safety and effectiveness of endovascular treatment as the first-line treatment for low-grade BAVMs.
Methods
From our local database, we retrospectively retrieved patients with low-grade BAVMs, either ruptured or unruptured, treated by embolization as first-line treatment in our department between January 2005 and January 2020. The primary endpoint was the total obliteration rate of BAVMs, and secondary endpoints were hemorrhagic complications and final clinical outcome, assessed through shift of the modified Rankin scale, and mortality rate secondary to BAVM embolization.
Results
A total of 145 patients meeting inclusion criteria and treated by EVT as first-line therapy were included in the study (82 ruptured and 63 unruptured BAVMs). Overall, complete exclusion of BAVMs was achieved in 110 patients (75.9%); 58 patients (70.7%) with ruptured and 52 (82.5%) unruptured BAVMs, including 37.9% BAVMs excluded by EVT alone (35.5% among ruptured and 44.4% among unruptured BAVMs) and 38% by combined treatment (EVT and surgery or EVT and SRS). There was no BAVM volume cut-off predictive for total obliteration by embolization alone. Early minor hemorrhagic complications were reported in 14 patients (9.6%) and early major hemorrhagic complications were reported in 5 patients (3.4%). No late hemorrhagic complications (0%) occurred; mortality rate was 0.7% (1/145 patients). Improved/unchanged mRS was reported in 137 patients (94.5%).
Conclusion
Endovascular treatment alone or associated with others exclusion techniques, might be safe and effective for complete exclusion of low-grade brain arteriovenous malformations regardless of the volume.