Department of Interventional Neuro-radiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France.
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah.
Neurosurgery. 2018 Nov 1;83(5):957-964. doi: 10.1093/neuros/nyx581.
Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs).
To assess contemporary outcomes of transvenous embolization as a stand-alone therapy for cerebral AVMs.
We prospectively followed 40 patients with 41 AVMs who underwent transvenous endovascular therapy between January 2008 and January 2015. Patient demographics, AVM characteristics, endovascular techniques used, angiographic results, clinical outcomes, and complications were assessed independently.
Thirty-eight of 41 (92.6%) AVMs were anatomically cured. The mean patient age was 37.7 yr (range, 18-69 yr) and 55% were female. Twenty-seven (67.5%) patients presented with hemorrhage. The mean size of the AVM nidus was 2.8 ± 1.2 cm, and low Spetzler-Martin grade AVMs comprised 41.5% of lesions. The majority of patients were treated in 1 session (56%; n = 23). The mean follow-up period was 28.4 (range, 6-106 mo). There was 1 (2.5%) hemorrhagic complication related to microcatheter navigation and 1 (2.5%) venous infarction was observed without clinical consequences. At 6-mo follow-up, 1 (2.5%) patient had significant disability. There were no recurrences during the follow-up period. Overall mortality was 2.5% and procedure-related mortality was 0%.
This prospective contemporary series demonstrates a high rate of complete AVM obliteration and excellent functional outcomes in patients with both ruptured and unruptured AVMs treated with transvenous embolization. This approach is promising and warrants further investigation as a treatment for select AVMs.
有治疗作用的经静脉栓塞术是治疗脑动静脉畸形（AVM）的新兴策略。
评估经静脉栓塞术作为脑 AVM 单一疗法的当代结果。
我们前瞻性地随访了 40 例于 2008 年 1 月至 2015 年 1 月期间接受经静脉血管内治疗的患者，共 41 例 AVM。独立评估了患者人口统计学特征、AVM 特征、使用的血管内技术、血管造影结果、临床结果和并发症。
41 例 AVM 中有 38 例（92.6%）解剖治愈。患者平均年龄为 37.7 岁（范围 18-69 岁），55%为女性。27 例（67.5%）患者有出血表现。AVM 病灶的平均大小为 2.8±1.2cm，低 Spetzler-Martin 分级 AVM 占病变的 41.5%。大多数患者接受 1 次治疗（56%；n=23）。平均随访时间为 28.4 个月（范围 6-106 个月）。有 1 例（2.5%）与微导管导航相关的出血性并发症，1 例（2.5%）观察到静脉梗死但无临床后果。6 个月随访时，1 例（2.5%）患者有显著残疾。随访期间无复发。总体死亡率为 2.5%，与操作相关的死亡率为 0%。
本前瞻性当代研究系列表明，在接受经静脉栓塞术治疗的破裂和未破裂 AVM 患者中，AVM 完全闭塞率高，且功能预后良好。这种方法很有前途，值得进一步研究，作为治疗特定 AVM 的方法。
