Target Embolization of Associated Aneurysms in Ruptured Arteriovenous Malformations.
OBJECTIVE
The purpose of this study was to examine the safety and efficacy of target embolization of aneurysms associated with ruptured brain arteriovenous malformations (BAVMs).


METHODS
Ruptured BAVM patients who underwent endovascular treatment at our institution from January 2011 to December 2015 were retrospectively reviewed. Patients were divided into aneurysm (AN) and nonaneurysm (non-AN) groups on the basis of the existence of BAVM-associated aneurysms or not. Demographics, angiographic characteristics, complications, and clinical outcomes were compared between 2 groups. Complication risk factors were analyzed for all objects. Patient outcomes were assessed with modified Rankin Scale (mRS).


RESULTS
A total of 129 (male = 53) patients were included. In 31 (24.0%) patients, 33 aneurysms were observed, including 16 intranidal and 17 flow-related aneurysms. Of the 166 sessions of embolization performed, there were 13 (10.1% of patients, 7.8% per session) complications in all, including 2 hemorrhagic, 8 transient ischemic, and 3 permanent ischemic types. There was no statistical difference in terms of complication incidence rate between groups. A total of 12 patients (9.3% of patients, 3.3% per person-year) experienced postoperative hemorrhage during follow-up (mean = 3.4 years). The yearly postoperative hemorrhage incidence rate was 3.4% in the non-AN group and 2.0% in AN group. Excellent or good outcomes (mRS ≤ 2) were observed in 103 (91.2%) patients. Unfavorable outcomes (mRS ≥ 3) as a direct result of embolization remained in no patients.


CONCLUSIONS
Target embolization of aneurysms associated with ruptured BAVMs could significantly decrease postoperative rehemorrhage without increasing complications.
Department of Neurosurgery, Beijing Neurosurgical Institute and Beijin Tiantan Hospital, Capital Medical University, The First People's Hospital of Lianyungang City, Jiangsu, China.
Yong
Y
Sun
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing, China.
Hengwei
H
Jin
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing, China. Electronic address: 727617920@qq.com.
Youxiang
Y
Li
Department of Neurosurgery, Jincheng People's Hospital, Jincheng City, China.
Zhihua
Z
Tian
D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000209:etiology* / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013635:Tantalum / Q000627:therapeutic use; D055815:Young Adult
D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
Associated aneurysm; Complication; Rehemorrhage; Ruptured brain arteriovenous malformations; Target embolization