From the Department of Interventional Neuroradiology (Y.H., W.B., T.L., J.X.), Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, and Henan Provincial Neurointerventional Engineering Research Center, Zhengzhou, China.
Department of Radiology (Y.D.), Mayo Clinic, Rochester, Minnesota.
AJNR Am J Neuroradiol. 2019 Oct;40(10):1744-1751. doi: 10.3174/ajnr.A6197. Epub 2019 Sep 19.
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.
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.
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).
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.
由于报告的病例数量非常有限，经静脉栓塞治疗脑动静脉畸形的疗效和安全性仍不清楚。本前瞻性研究旨在评估该技术在破裂的 AVM 中的应用。
2016 年 11 月至 2018 年 11 月期间，前瞻性随访了 21 例接受经静脉栓塞治疗的破裂脑 AVM 患者。3 例（14.3%）AVM 的 Spetzler-Martin 分级为 1 级，4 例（19.0%）为 2 级，11 例（52.4%）为 3 级，3 例（14.3%）为 4 级。根据 6 个月的 DSA 随访图像计算完全 AVM 闭塞率。术后 1 个月内通过 CT 和 MR 成像评估栓塞后出血和梗死的发生情况。采用 mRS 评估功能结局。
19 例技术可行的 AVM 患者中，16 例（84%）即刻栓塞后显示 AVM 巢完全闭塞。1 例（5%）治疗后有小残余巢的患者在 13 个月随访时完全闭塞。共发生 5 例出血和 1 例梗死；4 例患者症状逐渐改善。栓塞前 mRS≤2 的病例比例从 57.1%（21/21）上升到 1 个月随访时的 66.7%（14/21）。发病率和死亡率均为 4.8%（1/21）。
经静脉栓塞治疗仅适用于完全闭塞率高、功能预后改善、发病率和死亡率可接受的高度选择性出血性脑 AVM，但不应作为一线治疗。
