Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
Neuroradiol J. 2024 Dec;37(6):723-737. doi: 10.1177/19714009241260797. Epub 2024 Jun 7.
Few studies have investigated the safety of endovascular treatment (EVT) for brain arteriovenous malformations (BAVMs) via the anterior choroidal artery (AchA); therefore, this topic is worth studying further. This was a retrospective study of 18 consecutive patients with BAVMs that were treated via the AchA with Onyx casting. Clinical and angiographic data were collected from the patients and analyzed. The ages of the 18 patients ranged from 13 to 67 years (mean 39.2 ± 14.7 years), and eight patients were male (44.4%, 8/18). All patients had intracranial hemorrhages, including 2 with previous hemorrhages. All 18 BAVMs were mainly fed by the AchA and were treated via the AchA as the route for casting Onyx-18. Of the 13 single-trunk AchAs, after EVT, all proximal segments were preserved. For the 5 double-trunk AchAs, EVT was performed via the lower trunk; the proximal segments of the lower trunk were occluded for 2 of these AchAs. Among the 18 BAVMs, 16 niduses were embolized to different degrees, as were twelve associated aneurysms. Five (27.8%, 5/18) of the 18 patients experienced complications, and appropriate management was provided. During long-term follow-up, 14 (77.8%, 14/18) patients achieved good outcomes. EVT for BAVMs via the AchA has significant risks, but overall, good long-term outcomes were achieved in approximal 80% of the patients. This study highlights the potential of this technique for embolizing BAVMs via the AchA.
鲜有研究调查通过前脉络膜动脉（AchA）对脑动静脉畸形（BAVM）进行血管内治疗（EVT）的安全性；因此，这个话题值得进一步研究。这是一项回顾性研究，共纳入 18 例通过 AchA 用 Onyx 胶泥进行铸造治疗的 BAVM 患者。收集患者的临床和血管造影数据并进行分析。18 例患者的年龄为 13 至 67 岁（平均 39.2±14.7 岁），8 例为男性（44.4%，8/18）。所有患者均有颅内出血，其中 2 例有既往出血史。所有 18 例 BAVM 主要由 AchA 供血，均通过 AchA 作为铸造 Onyx-18 的入路进行治疗。在 13 例单干 AchA 中，EVT 后所有近端节段均得以保留。对于 5 例双干 AchA，通过下干进行 EVT，其中 2 例 AchA 的下干近端节段闭塞。在 18 例 BAVM 中，16 个巢有不同程度的栓塞，12 个相关动脉瘤也得到了栓塞。18 例患者中有 5 例（27.8%，5/18）出现并发症，给予了适当的处理。在长期随访中，14 例（77.8%，14/18）患者获得了良好的结局。通过 AchA 对 BAVM 进行 EVT 风险较大，但总体而言，近 80%的患者获得了良好的长期结局。本研究强调了该技术在通过 AchA 栓塞 BAVM 方面的潜力。
