title: Ruptured brain arteriovenous malformations associated with aneurysms: safety and efficacy of selective embolization in the acute phase of hemorrhage.
abstract: BACKGROUND
  The impact of targeted embolization of ruptured cerebral arteriovenous malformation (AVM)-associated arterial aneurysms in the acute phase of bleeding is not well known. The objective of our study was to analyze the safety and efficacy of this treatment strategy with special emphasis on its protective effect against rebleeding.
  
  
  METHODS
  From a prospective database, all patients presenting between December 2005 and March 2012 with a ruptured cerebral AVM associated with arterial aneurysms contiguous to the hemorrhage were selected. Hemorrhagic stroke severity and clinical outcome were measured using, respectively, Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) scores.
  
  
  RESULTS
  Twenty-five patients with ruptured cerebral AVMs associated with 31 arterial aneurysms contiguous with the hemorrhage were included. In the first group of 17 patients, the mean time to treatment was 30.1 h, while in the second group with 1 patient in poor initial clinical conditions and 7 admitted 7 to 28 days after bleeding, it was 17 days. All arterial aneurysms were totally occluded. Four patients presented rebleeding before treatment (mean interval 9.6 days) and four had rebleeding after treatment (mean interval 8.25 months). At a mean follow-up of 56 months, 21 patients were alive (19 mRS ≤ 2, 2 mRS > 2). Three patients died 2 days, 9 days, and 2 months after bleeding and another died of rebleeding of her residual AVM 19 months after treatment. Treatment-related morbidity and mortality were, respectively, 4 and 0%.
  
  
  CONCLUSIONS
  Selective embolization of arterial aneurysms associated with ruptured AVMs is a safe procedure and could lower the immediate risk of rebleeding.
authors: Department of Neurosurgery, Hospices Civils de Lyon, Université Claude Bernard, "Pierre Wertheimer", 59, Boulevard Pinel, 69500, Lyon, France, signorelli2007@gmail.com.
authors: Francesco
authors: F
authors: Signorelli
authors: Benjamin
authors: B
authors: Gory
authors: Isabelle
authors: I
authors: Pelissou-Guyotat
authors: Jacques
authors: J
authors: Guyotat
authors: Roberto
authors: R
authors: Riva
authors: Frédéric
authors: F
authors: Dailler
authors: Francis
authors: F
authors: Turjman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult