Acute embolization of ruptured brain arteriovenous malformations.

MedStar author(s):
Citation: Journal of Neurointerventional Surgery. 5(3):196-200, 2013 May.PMID: 22406978Institution: MedStar Washington Hospital CenterDepartment: RadiologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Arteriovenous Fistula/ra [Radiography] | *Arteriovenous Fistula/th [Therapy] | *Embolization, Therapeutic/mt [Methods] | *Intracranial Arteriovenous Malformations/ra [Radiography] | *Intracranial Arteriovenous Malformations/th [Therapy] | Adolescent | Adult | Aged | Child | Female | Follow-Up Studies | Humans | Male | Middle Aged | Prospective Studies | Retrospective Studies | Time Factors | Young AdultYear: 2013Local holdings: Available online through MWHC library: 2009 - presentISSN:
  • 1759-8478
Name of journal: Journal of neurointerventional surgeryAbstract: BACKGROUND: Ruptured brain arteriovenous malformations (bAVMs) are at increased risk of re-hemorrhage but management has historically been conservative. This is because: (1) ruptured bAVMs have not been considered as catastrophic as ruptured cerebral aneurysms, (2) surgical resection is aided by waiting for brain edema to resolve and clot to liquefy and (3) fear exists that partially treated bAVMs may be more dangerous than those untreated. The purpose of this study was to determine the feasibility and safety of acute embolization in patients with ruptured bAVMs.CONCLUSION: Treatment of ruptured bAVMs is often delayed but our experience with Onyx suggests that acute embolization is safe and feasible.METHODS: 21 consecutive patients who underwent acute embolization of ruptured bAVMs from 2007 to 2011 were retrospectively reviewed. All treatments consisted of embolization exclusively using Onyx liquid embolic agent. Neurological outcomes were assessed using the Glasgow Outcome Scale (GOS) at hospital discharge following initial treatment.RESULTS: Nine patients (43%) were male, mean age was 38 years (range 8-75) and initial embolization was performed at a median of 4 days after ictus (mean 5.8, range 0-19). Spetzler-Martin grades ranged from I to VI (mean 3, median 3). In seven patients (33%) the AVM was completely occluded with a single treatment. With subsequent embolizations, complete occlusion occurred in four additional patients (19%). Six patients (29%) had post-embolization AVM resection and one patient (5%) had post-embolization gamma knife irradiation. None has suffered subsequent hemorrhages (mean follow-up 7.5 months). The mean discharge GOS of all patients was 4.4 (range 1-5).All authors: Armonda RA, Bank WO, Bell RS, Herzig DW, Liu AH, Stemer ABFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2014-02-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22406978 Available 22406978

Available online through MWHC library: 2009 - present

BACKGROUND: Ruptured brain arteriovenous malformations (bAVMs) are at increased risk of re-hemorrhage but management has historically been conservative. This is because: (1) ruptured bAVMs have not been considered as catastrophic as ruptured cerebral aneurysms, (2) surgical resection is aided by waiting for brain edema to resolve and clot to liquefy and (3) fear exists that partially treated bAVMs may be more dangerous than those untreated. The purpose of this study was to determine the feasibility and safety of acute embolization in patients with ruptured bAVMs.

CONCLUSION: Treatment of ruptured bAVMs is often delayed but our experience with Onyx suggests that acute embolization is safe and feasible.

METHODS: 21 consecutive patients who underwent acute embolization of ruptured bAVMs from 2007 to 2011 were retrospectively reviewed. All treatments consisted of embolization exclusively using Onyx liquid embolic agent. Neurological outcomes were assessed using the Glasgow Outcome Scale (GOS) at hospital discharge following initial treatment.

RESULTS: Nine patients (43%) were male, mean age was 38 years (range 8-75) and initial embolization was performed at a median of 4 days after ictus (mean 5.8, range 0-19). Spetzler-Martin grades ranged from I to VI (mean 3, median 3). In seven patients (33%) the AVM was completely occluded with a single treatment. With subsequent embolizations, complete occlusion occurred in four additional patients (19%). Six patients (29%) had post-embolization AVM resection and one patient (5%) had post-embolization gamma knife irradiation. None has suffered subsequent hemorrhages (mean follow-up 7.5 months). The mean discharge GOS of all patients was 4.4 (range 1-5).

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