From the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France
From the Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France.
AJNR Am J Neuroradiol. 2020 Dec;41(12):2311-2316. doi: 10.3174/ajnr.A6810. Epub 2020 Oct 29.
Intracranial hemorrhage represents a severe complication of brain arteriovenous malformation treatment. The aim of this cohort was to report the rate of hemorrhagic complications after transvenous endovascular embolization and analyze the potential angioarchitectural risk factors as well as clinical outcomes.
During an 11-year period, 57 patients underwent transvenous endovascular embolization. All cases of hemorrhagic complications were identified. We analyzed the following variables: sex, age, hemorrhagic presentation, Spetzler-Martin grade, size of the AVM before the transvenous treatment, number of venous collectors, pattern of drainage, presence of dilated veins, and technical aspects. Univariate and multivariate multiple regression analyses were performed to evaluate the potential risk factors for procedure-related hemorrhagic complications.
Hemorrhagic complications (either intraprocedural or periprocedural) unrelated to a perforation due to micronavigation occurred in 8 (14.0%) procedures. Significant (mRS > 2) and persistent neurologic deficits were present in 2 (3.5%) patients at 6-month control. Larger nidi, especially >3 cm ( = .03), and a larger number of venous collectors have shown a statistically significant correlation with hemorrhagic complications. Only the number of venous collectors was identified as an independent predictor of hemorrhagic complications in the multivariate analysis (OR, 8.7; 95% confidence interval, 2.2-58.2) (= .006).
Larger nidus sizes and an increased number of venous collectors may increase the risk of hemorrhagic complications when implementing transvenous endovascular treatment of AVMs. The technique is effective and promising, especially with small nidi and single venous collectors.
颅内出血是脑动静脉畸形治疗的严重并发症。本队列研究旨在报告经静脉血管内栓塞治疗后出血并发症的发生率，并分析潜在的血管构筑风险因素及临床转归。
在 11 年期间，57 例患者接受了经静脉血管内栓塞治疗。所有出血并发症均被明确诊断。我们分析了以下变量：性别、年龄、出血表现、Spetzler-Martin 分级、静脉治疗前动静脉畸形的大小、静脉收集器的数量、引流模式、扩张静脉的存在以及技术方面。采用单变量和多变量多元回归分析评估与手术相关的出血并发症的潜在风险因素。
与因微导航导致的穿孔无关的术中或围手术期出血并发症在 8 例（14.0%）手术中发生。在 6 个月的随访中，2 例（3.5%）患者出现显著（mRS>2）和持续的神经功能缺损。较大的病灶，尤其是>3cm（ = .03），以及更多的静脉收集器与出血并发症具有统计学显著相关性。只有静脉收集器的数量在多变量分析中被确定为出血并发症的独立预测因子（OR，8.7；95%置信区间，2.2-58.2）（ = .006）。
较大的病灶大小和更多的静脉收集器数量可能会增加实施动静脉畸形经静脉血管内栓塞治疗时出血并发症的风险。该技术是有效和有前途的，尤其是在病灶较小和静脉收集器单一的情况下。
