Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations.

Details

Serval ID
serval:BIB_E5E1C9EA01A7
Type
Article: article from journal or magazin.
Collection
Publications
Title
Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations.
Journal
AJNR. American journal of neuroradiology
Author(s)
Baharvahdat H., Blanc R., Termechi R., Pistocchi S., Bartolini B., Redjem H., Piotin M.
ISSN
1936-959X (Electronic)
ISSN-L
0195-6108
Publication state
Published
Issued date
05/2014
Peer-reviewed
Oui
Volume
35
Number
5
Pages
978-983
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Intracranial hemorrhage is the most severe complication of brain arteriovenous malformation treatment. We report our rate of hemorrhagic complications after endovascular treatment and analyze the clinical significance and potential mechanisms, with emphasis on cases of delayed hemorrhage after uneventful embolization.
During a 10-year period, 846 embolization procedures were performed in 408 patients with brain AVMs. Any cases of hemorrhagic complications were identified and divided into those related or unrelated to a periprocedural arterial tear (during catheter navigation or catheter retrieval). We analyzed the following variables: sex, age, hemorrhagic presentation, Spetzler-Martin grade, size of the AVM, number of embolized pedicles, microcatheter used, type and volume of liquid embolic agent injected, and the presence of a premature venous occlusion. Univariate and multivariate multiple regression analyses were performed to identify risk factors for hemorrhagic complications.
A hemorrhagic complication occurred in 92 (11%) procedures. Forty-four (48%) complications were related to a periprocedural arterial perforation, and 48 (52%) were not. Hemorrhagic complications unrelated to an arterial perforation were located more commonly in the cerebral parenchyma, caused more neurologic deficits, and were associated with worse prognosis than those in the arterial perforation group. Only premature venous occlusion was identified as an independent predictor of hemorrhagic complication in the nonperforation group. Premature venous occlusion was significantly related to the ratio of Onyx volume to nidus diameter.
Higher injected volume of embolic agent and deposition on the venous outflow before complete occlusion of the AVM may account for severe hemorrhagic complications.

Keywords
Adult, Causality, Cerebral Hemorrhage/diagnostic imaging, Cerebral Hemorrhage/etiology, Cerebral Hemorrhage/mortality, Comorbidity, Embolization, Therapeutic/adverse effects, Embolization, Therapeutic/mortality, Endovascular Procedures/adverse effects, Endovascular Procedures/mortality, Female, Hemostatics/adverse effects, Hemostatics/therapeutic use, Humans, Incidence, Intracranial Arteriovenous Malformations/diagnostic imaging, Intracranial Arteriovenous Malformations/mortality, Intracranial Arteriovenous Malformations/surgery, Male, Radiography, Retrospective Studies, Risk Factors, Treatment Outcome
Pubmed
Open Access
Yes
Create date
03/05/2017 11:44
Last modification date
20/08/2019 16:09
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