Picard L, Da Costa E, Anxionnat R, Macho J, Bracard S, Per A, Marchal J C
Departments of Diagnostic and Interventional Neuroradiology, Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.
J Neuroradiol. 2001 Sep;28(3):147-65.
To investigate factors predisposing to spontaneous hemorrhage in the early period after embolization of brain arteriovenous malformations (AVMs).
The authors report 15 cases of spontaneous hemorrhage in a consecutive series of 492 brain AVMs totally or partially treated with intranidal injections of a polymerizing mixture, from 1984 to June 1998. Retrospective analysis of the records was performed with special attention to the angio-architectural features before embolization, details of embolization procedures and induced angiographic modifications.
Pre-embolization features of greater incidence were the presence of steal phenomena (87%), multiple feeding arteries (100%), a compact aspect of the nidus (93%), and lobar topography (87%). In most cases the volume of injected glue exceeded 1 ml (80%), venous embolization was significant (67%) and immediate angiographic control showed venous stagnation in and/or around the nidus (80%). Four patients were asymptomatic (incidental discovery on systematic CT at day 3). Among the remaining 11 symptomatic patients, 6 were operated to evacuate an intracerebral hematoma, outcome was good for 4, 5 were left with sequelae and 2 died.
Spontaneous hemorrhagic complications affected 3.04% of embolized patients. The combination of certain angio-architectural features, significant venous embolization and persistent venous stagnation within the nidus seem to have some predictive value of high risk hemorrhage. In light of this, additional preventive measures must be taken and a neurosurgical team systematically kept on standby.
探讨脑动静脉畸形（AVM）栓塞术后早期发生自发性出血的相关因素。
作者报告了1984年至1998年6月期间，492例接受瘤内注射聚合混合物进行全栓塞或部分栓塞治疗的脑AVM患者中，发生15例自发性出血的情况。对记录进行回顾性分析，特别关注栓塞前的血管构筑特征、栓塞过程细节及诱导的血管造影改变。
栓塞前发生率较高的特征包括盗血现象（87%）、多支供血动脉（100%）、瘤巢致密（93%）及叶性分布（87%）。多数情况下，注入的胶水体积超过1 ml（80%），静脉栓塞显著（67%），即时血管造影显示瘤巢内和/或周围静脉淤滞（80%）。4例患者无症状（术后第3天CT检查偶然发现）。其余11例有症状的患者中，6例接受手术清除脑内血肿，4例预后良好，5例留有后遗症，2例死亡。
自发性出血并发症在栓塞患者中的发生率为3.04%。某些血管构筑特征、显著的静脉栓塞及瘤巢内持续的静脉淤滞似乎对高风险出血有一定的预测价值。鉴于此，必须采取额外的预防措施，并系统地安排神经外科团队随时待命。
