title: Predictors of neurological deficit after endovascular treatment of cerebral arteriovenous malformations and functional repercussions in prospective follow-up.
abstract: Endovascular therapy is a well-established approach to the treatment of cerebral arteriovenous malformations (AVMs). The objective of this study was to determine the predictive factors of neurological deficit following endovascular procedures. Seventy-one patients with cerebral AVMs who underwent 147 embolization sessions from 2006 to 2011 were followed up prospectively (average 31.1 ± 17.5 months). Functional neurological condition was documented by means of the modified Rankin scale. Factors found to be predictors of neurological deficit were the partial obstruction of drainage veins (OR = 197.6; IC = 2.76 -1416.0; P = 0.015), a positive result in the Propofol test (OR = 50.2; IC = 6.18 - 566.5; P = 0.000), AVM diameter under 3 cm (OR = 21.3; IC: 1.71 - 265.6; P = 0.018), the presence of intranidal aneurysms (OR = 11.2; IC = 1.09 - 114.2; P = 0.042), the absence of post-procedure hypotension (OR = 10.2; IC = 1.35 - 77.7; P = 0.003), deep venous drainage (OR = 7.14; IC = 1.15 - 44.4; P = 0.035), and devascularization in excess of 40% per session (OR = 3.3; IC = 1.11 - 16.8; P = 0.056). Fifty-six patients (78.9%) did not experience changes in their neurological condition after the treatment and 13 patients (18.3%) showed a new neurological deficit related to the treatment; 95.8 % of the patients did not show significant long-term incapacity. Partial obstruction of drainage veins, small AVMs, intranidal aneurysms, faulty hemodynamic control and extensive devascularization were found to be predictors of neurological deficit. A significant number of patients with neurological deficit improved in the long term.
authors.affiliation: Interventional Neuroradiology Unit, CIMEQ, Institute of Neurology and Neurosurgery; La Habana, Cuba - pereraelianne@infomed.sld.cu.
authors.forename: Jose
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Interventional Neuroradiology Unit, CIMEQ, Institute of Neurology and Neurosurgery; La Habana, Cuba.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Llibre
authors.affiliation: Interventional Neuroradiology Unit, CIMEQ, Institute of Neurology and Neurosurgery; La Habana, Cuba.
authors.forename: Frank
authors.initials: F
authors.lastname: Vazquez
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: arteriovenous malformations; embolization; neurological deficit; predictive factors