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Research ArticleINTERVENTIONAL

Selection of Patients for Treatment of Brain Arteriovenous Malformations by the Transvenous Approach: Relationship with Venous Anatomy and Risk of Hemorrhagic Complications

J.M.B. De Sousa, C. Iosif, L.Z. Sganzerla, A.N. Rafie, V. Borodetsky, A. Rouchaud, S. Saleme and C. Mounayer
American Journal of Neuroradiology October 2020, DOI: https://doi.org/10.3174/ajnr.A6810
J.M.B. De Sousa
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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C. Iosif
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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L.Z. Sganzerla
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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A.N. Rafie
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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V. Borodetsky
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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A. Rouchaud
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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S. Saleme
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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C. Mounayer
aFrom the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
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Abstract

BACKGROUND AND PURPOSE: Intracranial hemorrhage represents a severe complication of brain arteriovenous malformation treatment. The aim of this cohort was to report the rate of hemorrhagic complications after transvenous endovascular embolization and analyze the potential angioarchitectural risk factors as well as clinical outcomes.

MATERIALS AND METHODS: During an 11-year period, 57 patients underwent transvenous endovascular embolization. All cases of hemorrhagic complications were identified. We analyzed the following variables: sex, age, hemorrhagic presentation, Spetzler-Martin grade, size of the AVM before the transvenous treatment, number of venous collectors, pattern of drainage, presence of dilated veins, and technical aspects. Univariate and multivariate multiple regression analyses were performed to evaluate the potential risk factors for procedure-related hemorrhagic complications.

RESULTS: Hemorrhagic complications (either intraprocedural or periprocedural) unrelated to a perforation due to micronavigation occurred in 8 (14.0%) procedures. Significant (mRS > 2) and persistent neurologic deficits were present in 2 (3.5%) patients at 6-month control. Larger nidi, especially >3 cm (P = .03), and a larger number of venous collectors have shown a statistically significant correlation with hemorrhagic complications. Only the number of venous collectors was identified as an independent predictor of hemorrhagic complications in the multivariate analysis (OR, 8.7; 95% confidence interval, 2.2–58.2) (P = .006).

CONCLUSIONS: Larger nidus sizes and an increased number of venous collectors may increase the risk of hemorrhagic complications when implementing transvenous endovascular treatment of AVMs. The technique is effective and promising, especially with small nidi and single venous collectors.

ABBREVIATIONS:

bAVM
brain arteriovenous malformation
HC
hemorrhagic complications
TVE
transvenous endovascular embolization
  • © 2020 by American Journal of Neuroradiology
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Selection of Patients for Treatment of Brain Arteriovenous Malformations by the Transvenous Approach: Relationship with Venous Anatomy and Risk of Hemorrhagic Complications
J.M.B. De Sousa, C. Iosif, L.Z. Sganzerla, A.N. Rafie, V. Borodetsky, A. Rouchaud, S. Saleme, C. Mounayer
American Journal of Neuroradiology Oct 2020, DOI: 10.3174/ajnr.A6810

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Selection of Patients for Treatment of Brain Arteriovenous Malformations by the Transvenous Approach: Relationship with Venous Anatomy and Risk of Hemorrhagic Complications
J.M.B. De Sousa, C. Iosif, L.Z. Sganzerla, A.N. Rafie, V. Borodetsky, A. Rouchaud, S. Saleme, C. Mounayer
American Journal of Neuroradiology Oct 2020, DOI: 10.3174/ajnr.A6810
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