Introduction Treatment of deep-seated, previously-bled brain AVM unsuitable for microsurgery and radiosurgery remains a challenge. At the same time, the risk of rebleeding in such lesions is 32.9%–47.7% according to literature. Transvenous approach could be usable for embolization of the AVMs and can increase the chances of complete obliteration. The aim of the study was to compare the rates of complete obliteration and complications in the series of transvenous (TVA) and transarterial (TAA) approaches of the patients with deep hemorrhagic brain AVMs Spetzler-Martin (SM) III-IV.
Materials and methods 58 patients with deep hemorrhagic brain AVMs SM III-IV were treated in the single center between 2011 and 2017. 44 patients were completely treated, ranging in age from 7 to 68 (mean, 31.3). All patients had the first-time embolization. According to mRS before the treatment 32 patients (55.1%) had ‘0’, 16 (27.6%) – ‘1’, 4 (6.9%) – ‘2’, 3 (5.2%) – ‘3’ and 3 (5.2%) – ‘4’. Two groups of patients were assigned retrospectively into 2 groups. In the first group – 17 (38.6%) TVA, and in the second group TAA – 27 (61.4%) was conducted. Comparison of the groups was carried out using χ-square method.
Results and discussion The complete occlusion was achieved in 94.1% for transvenous approach; a small residual nidus was left in one case. This patient was successfully treated using radiosurgery following to embolization. In the this group, patients got 7 complications (2 ischemic and 5 hemorrhagic). One patient had increase in mRS score at discharge. The total mortality in this group reached 17.7% (3 patients). The complete obliteration of TAA was achieved in 55.6%. For the rest of patients, further embolization is impossible. In this group of patients 11 procedure-related complications occurred (5 ischemic and 6 hemorrhagic), which included morbidity of 3.7% and mortality of 14.8%. Statistically significant difference was identified using χ-square method in the complete obliteration (p<0.01), however, it is not reliable in case of mortality (p=0.736) and complication rates (p=0.775).
Conclusion The results showed that transvenous approach is reliable, effective and safe technique for treatment of patients with SM high-grade brain AVMs in selected cases, which establishes additional option for neurosurgeons. Further investigation of TVA allows to widen area of its application and to create more precise protocols for endovascular management of brain AVMs.
Disclosures M. Demyanovskaya: None. N. Strelnikov: None. A. Moskalev: None. K. Orlov: None.
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