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SNIS 8th annual meeting oral abstracts
O-013 Targeted treatment of bleeding source in arteriovenous malformations presenting with hemorrhage
  1. A Taylor,
  2. N Mjoli,
  3. D Lefeuvre
  1. Department of Neurosurgery, University of Cape Town, Cape Town, South Africa


Introduction 50% of symptomatic cerebral arteriovenous malformations (AVM) present because of intracranial hemorrhage. The future bleeding risk in these patients is higher than that for patients presenting with seizures, headaches or neurological deficit for at least 2 years. The reason for this higher risk may be related to partial healing of the initial rupture site.

Purpose We sought first to determine if the angiographic source of hemorrhage could be identified in patients with intracranial bleeding. Second if the bleeding point was visualized could we safely exclude this weakness using endovascular treatment.

Method A database of AVM patients was examined and all patients presenting with intracranial hemorrhage were included in the study. Demographic and clinical information was obtained from clinical notes. All scans and angiograms were reviewed by the investigators. Where the hemorrhage coincided anatomically with an angiographic weakness such as intranidal false aneurysm, proximal flow related aneurysm or venous pouch the bleeding point was recorded as identified. In the patients where no angiographic weakness could be seen or it was not correlated with the bleed, the bleeding source was recorded as not discovered. Treatment of the AVM weak point was recorded as successful if it could be endovascularly excluded.

Results Over a 6-year period 99 new patients presented because of a cerebral AVM and of these 42 presented with hemorrhage. In 19 out of the 42 patients (45%) the source of bleeding was identified and treatment was performed (Abstract O-013 table 1). In all but two patients were able to treat the weak area. Of the 42 patients presenting with hemorrhage 38 had endovascular therapy and there were two minor procedure related complications (5%).

Abstract O-013 Table 1

Bleeding source

Conclusion In 45% of AVM's presenting with hemorrhage we were able to identify the bleeding point on digital subtraction angiography. Targeted treatment of these weak areas is possible in most cases at an acceptable risk.

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