Piotin M, Ross I B, Weill A, Kothimbakam R, Moret J
Department of Interventional and Functional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, 75940 Paris Cedex 19, France.
Radiology. 2001 Aug;220(2):506-13. doi: 10.1148/radiology.220.2.r01au09506.
To evaluate the results of endovascular treatment of patients having both arteriovenous malformations and aneurysms.
Two hundred seventy consecutive patients underwent pretherapeutic selective and superselective angiography. In each patient, the following were recorded: demographic information; clinical symptoms; location of the arteriovenous malformation, including presence of aneurysms; therapeutic interventions and immediate anatomic results; and clinical and angiographic follow-up data. Every patient who had at least one angiographically confirmed arterial aneurysm at presentation was included in the study.
Arterial aneurysms were found in 30 (11%) of 270 patients in the population with arteriovenous malformations. Fifteen (50%) of 30 patients with aneurysms had a hemorrhage at presentation. Only 66 (27.5%) of 240 patients without aneurysms had a hemorrhage at presentation. The coexistence of arteriovenous malformations and aneurysms correlated significantly with intracranial hemorrhage at presentation (P <.05). When an aneurysm was believed to be responsible for a hemorrhage and whenever possible, it was treated before the arteriovenous malformation was treated. Treatments were protective against hemorrhage or recurrence of hemorrhage in all cases. Five of 30 patients had neurologic deficits as a result of endovascular treatment of both aneurysms and arteriovenous malformations.
Findings in this study highlight the importance of recognizing aneurysms in patients with arteriovenous malformations. A strategic focus on the circulatory exclusion of associated aneurysms, especially when such lesions have been responsible for a hemorrhagic episode, is recommended.
评估患有动静脉畸形和动脉瘤患者的血管内治疗结果。
连续270例患者接受了治疗前的选择性和超选择性血管造影。记录每位患者的以下信息：人口统计学信息；临床症状；动静脉畸形的位置，包括动脉瘤的存在情况；治疗干预措施和即刻解剖学结果；以及临床和血管造影随访数据。每例在就诊时至少有一个经血管造影证实的动脉性动脉瘤的患者均纳入本研究。
在270例患有动静脉畸形的患者中，30例（11%）发现有动脉性动脉瘤。30例患有动脉瘤的患者中，15例（50%）在就诊时有出血情况。240例无动脉瘤的患者中，仅有66例（27.5%）在就诊时有出血情况。动静脉畸形和动脉瘤的共存与就诊时的颅内出血显著相关（P<.05）。当认为动脉瘤是出血的原因且可能时，在治疗动静脉畸形之前先对其进行治疗。在所有病例中，治疗均预防了出血或出血复发。30例患者中有5例因对动脉瘤和动静脉畸形进行血管内治疗而出现神经功能缺损。
本研究结果突出了识别动静脉畸形患者中动脉瘤的重要性。建议策略性地重点关注相关动脉瘤的循环闭塞，尤其是当此类病变导致出血发作时。
