Curative Transvenous Embolization for Ruptured Brain Arteriovenous Malformations: A Single-Center Experience from China

• Published in: World neurosurgery 2018-08, Vol.116, p.e421-e428
• Main Authors: He, Yingkun, Bai, Weixing, Li, Tianxiao, Hui, Ferdinand K., He, Yanyan, Xu, Bin
• Format: Article
• Language: English
• Subjects: Brain arteriovenous malformation; Embolization; Internal jugular vein approach
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.04.223

To evaluate feasibility and safety of transvenous embolization for brain arteriovenous malformations (AVMs). Between November 2016 and August 2017, a transvenous endovascular embolization protocol was implemented at the Henan Provincial People's Hospital for consecutive patients with ruptured brain AVMs. Therapeutic decision making was based on Spetzler-Martin grade, brain AVM location, pattern of venous drainage, and angioarchitecture. Transvenous embolization was combined with transarterial support. Complete angiographic obliteration of the nidus was the objective of treatment. Among 10 patients with ruptured brain AVMs, 8 were male. Spetzler-Martin grades before transvenous embolization were IV in 3 patients, III in 5 patients, II in 1 patient, and I in 1 patient. Modified Rankin Scale score before the procedure was 0–2 for 6 of 10 patients. Five patients also had deep venous drainage. Arterial blood pressure control and venous pressure cooker technique were used in all 10 patients; 9 patients had immediate angiographic occlusion. Two patients had a ventricular hemorrhage, which did not cause any disability after medical treatment. Seven patients underwent angiography 3–5 months after the procedure, and complete obliteration of the nidus was confirmed. Median clinical follow-up for all 10 patients was 8 months (range, 3–12 months). Epilepsy occurred in 1 patient 3 months after the procedure, and modified Rankin Scale scores for all patients were ≤1. Transvenous embolization of brain AVMs is feasible and may improve cure rates. The safety and long-term effects need further validation. •This is the first case series from China on transvenous embolization for ruptured brain AVMs.•The transvenous pressure cooker technique with just 1 microcatheter was used.•This is the first report describing the transvenous pressure cooker technique.