Maichael Talaat1,2, Eimad Shotar1, Kévin Premat1, Anne-Laure Boch3, Mariette Delaitre4, Pierre-Yves Borius3, Aurelien Nouet3, Stéphanie Lenck1, Atika Talbi1, Awad Bessar2, Mohammed Taema2, Ahmed Bessar2, Farouk Hassan5, Tamer S Elserafy6, Etienne Lefevre3, Vincent Degos7,8, Nader Sourour1, Frédéric Clarençon9,10. 1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 2. Department of Radiology, Zagazig University, Faculty of Medicine, E44519, Zagazig, Egypt. 3. Department of Neurosurgery, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 4. Department of Interventional Neuroradiology, Centre Hospitalier de Colmar, Colmar, France. 5. Department of Radiology, Cairo University, Faculty of Medicine, C12613, Cairo, Egypt. 6. Department of Neurology, Zagazig University, Faculty of Medicine, E44519, Zagazig, Egypt. 7. Department of Anesthesiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 8. GRC BioFast, Sorbonne University, Paris, France. 9. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. frederic.clarencon@aphp.fr. 10. GRC BioFast, Sorbonne University, Paris, France. frederic.clarencon@aphp.fr.
Abstract
PURPOSE: Spetzler-Martin grade (SMG) I-II (low-grade) brain arteriovenous malformations (BAVMs) are often considered safe for microsurgical resection; however, the role of endovascular treatment (EVT) remains to be clarified in this indication, especially for unruptured BAVMs. The purpose of our study was to assess the safety and effectiveness of endovascular treatment as the first-line treatment for low-grade BAVMs. METHODS: From our local database, we retrospectively retrieved patients with low-grade BAVMs, either ruptured or unruptured, treated by embolization as first-line treatment in our department between January 2005 and January 2020. The primary endpoint was the total obliteration rate of BAVMs, and secondary endpoints were hemorrhagic complications and final clinical outcome, assessed through shift of the modified Rankin scale, and mortality rate secondary to BAVM embolization. RESULTS: A total of 145 patients meeting inclusion criteria and treated by EVT as first-line therapy were included in the study (82 ruptured and 63 unruptured BAVMs). Overall, complete exclusion of BAVMs was achieved in 110 patients (75.9%); 58 patients (70.7%) with ruptured and 52 (82.5%) unruptured BAVMs, including 37.9% BAVMs excluded by EVT alone (35.5% among ruptured and 44.4% among unruptured BAVMs) and 38% by combined treatment (EVT and surgery or EVT and SRS). There was no BAVM volume cut-off predictive for total obliteration by embolization alone. Early minor hemorrhagic complications were reported in 14 patients (9.6%) and early major hemorrhagic complications were reported in 5 patients (3.4%). No late hemorrhagic complications (0%) occurred; mortality rate was 0.7% (1/145 patients). Improved/unchanged mRS was reported in 137 patients (94.5%). CONCLUSION: Endovascular treatment alone or associated with others exclusion techniques, might be safe and effective for complete exclusion of low-grade brain arteriovenous malformations regardless of the volume.
PURPOSE: Spetzler-Martin grade (SMG) I-II (low-grade) brain arteriovenous malformations (BAVMs) are often considered safe for microsurgical resection; however, the role of endovascular treatment (EVT) remains to be clarified in this indication, especially for unruptured BAVMs. The purpose of our study was to assess the safety and effectiveness of endovascular treatment as the first-line treatment for low-grade BAVMs. METHODS: From our local database, we retrospectively retrieved patients with low-grade BAVMs, either ruptured or unruptured, treated by embolization as first-line treatment in our department between January 2005 and January 2020. The primary endpoint was the total obliteration rate of BAVMs, and secondary endpoints were hemorrhagic complications and final clinical outcome, assessed through shift of the modified Rankin scale, and mortality rate secondary to BAVM embolization. RESULTS: A total of 145 patients meeting inclusion criteria and treated by EVT as first-line therapy were included in the study (82 ruptured and 63 unruptured BAVMs). Overall, complete exclusion of BAVMs was achieved in 110 patients (75.9%); 58 patients (70.7%) with ruptured and 52 (82.5%) unruptured BAVMs, including 37.9% BAVMs excluded by EVT alone (35.5% among ruptured and 44.4% among unruptured BAVMs) and 38% by combined treatment (EVT and surgery or EVT and SRS). There was no BAVM volume cut-off predictive for total obliteration by embolization alone. Early minor hemorrhagic complications were reported in 14 patients (9.6%) and early major hemorrhagic complications were reported in 5 patients (3.4%). No late hemorrhagic complications (0%) occurred; mortality rate was 0.7% (1/145 patients). Improved/unchanged mRS was reported in 137 patients (94.5%). CONCLUSION: Endovascular treatment alone or associated with others exclusion techniques, might be safe and effective for complete exclusion of low-grade brain arteriovenous malformations regardless of the volume.
Authors: H Baharvahdat; R Blanc; R Fahed; S Smajda; G Ciccio; J-P Desilles; H Redjem; S Escalard; M Mazighi; D Chauvet; T Robert; P Sasannejad; M Piotin Journal: AJNR Am J Neuroradiol Date: 2019-02-21 Impact factor: 3.825
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