TY - JOUR T1 - Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1744 LP - 1751 DO - 10.3174/ajnr.A6197 VL - 40 IS - 10 AU - Y. He AU - Y. Ding AU - W. Bai AU - T. Li AU - F.K. Hui AU - W.-J. Jiang AU - J. Xue Y1 - 2019/10/01 UR - http://www.ajnr.org/content/40/10/1744.abstract N2 - BACKGROUND AND PURPOSE: The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs.MATERIALS AND METHODS: Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes.RESULTS: Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS ≤ 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21).CONCLUSIONS: Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment. ER -