Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations: a single-center prospective study
Background The treatment of low grade SpetzlerMartin (SM) brain arteriovenous malformations (AVMs) has been debated in unruptured cases. Nevertheless, in clinical practice there are cases where treatment is preferred; in these cases a very low complication rate is mandatory. In ruptured cases, early and complete obliteration of the nidus is the preferred strategy. Objective To achieve curative embolization, ideally in a single session, by dual microcatheterization techniques with arterial and/or venous access, according to the angioarchitecture. Materials and methods This is a prospective, single-center study carried out between January 2008 and January 2016. Patients with ruptured and unruptured brain AVMs, with SM grades I and II, treated by endovascular means, were included. Demographics, clinical presentation, angioarchitecture, and procedurerelated complications were analyzed. Angiographic and clinical results were reported. Results Seventy-three patients, aged 40.5±17.8 years, were included. More than 60% of the patients presented with ruptured AVMs. Initial SM grades were I for 22% and II for 78% of the patients. Preprocedural modified Rankin Scale (mRS) score was 0–2 for 53 (72.6%), 3 for 12 (16.4%), 4 for 5 (6.8%) and 5 for 3 (4.1%) patients. Procedure-related morbidity was 2.7% and procedurerelated mortality was 0%. Ninety percent (90.5%) of the patients were independent in their everyday lives (mRS score 0–2) at 6months. In all but one case (95%) the embolization was curative. Conclusion Stand-alone endovascular treatment for SM grade I and II brain AVMs seems safe and effective, allowing for complete obliteration of the nidus, with low complication rates. A study of larger cohorts is needed.
|Persistent URL||dx.doi.org/10.1136/neurintsurg-2018-014390, hdl.handle.net/1765/117862|
|Journal||Journal of Neurointerventional Surgery|
Iosif, C., de Lucena, A.F., Abreu-Mattos, L.G., Ala, V.H.E., El-Ghanam, A., Saleme, S., … Mounayer, C. (2019). Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations: a single-center prospective study. Journal of Neurointerventional Surgery, 11(7), 699–705. doi:10.1136/neurintsurg-2018-014390