Journal of Cerebrovascular Disease 2018 Vol.1 No.1 1-42
Curative Embolization of Supratentorial Arteriovenous Malformation by an Initial Single Session: A Statistical Study on the Potential and Angiographic Predictors
Author(s):
Jian-Wei Pan1,Hong-Wei He2,Lei Feng3,Zhong-Xue Wu3,Shu-Sen Zheng4
Affiliation(s):
1Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University, School of Medicine
2Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
3Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, California
4Department of Surgery, The First Affiliated Hospital, Zhejiang University, School of Medicine
Corresponding Author:
Shu-Sen Zheng
Corresponding email(s):
zyzsss@zju.edu.cn
Key Words:
Embolization; Arteriovenous malformations; Onyx
Background: Through endovascular therapy of brain arteriovenous malformations (AVMs), the curative effect of embolization and the post-embolic complications are still being debated. This study aims to assess the outcomes, complications and angiographic predictors of curative effects after an initial Onyx-18 embolization for supratentorial brain AVMs (sbAVMs).
Methods: The clinical and angiographic characteristics of sbAVM patients presenting with initial embolization at our institutions from 2005 to 2008 were retrospectively reviewed. Univariate and multivariate analyses were conducted to assess the angiographic features in patients with and without total occlusion of sbAVMs.
Results: In 130 patients with sbAVMs who were initially embolized by Onyx-18, there were 28 complete (21.5%), and 102 non-complete embolizations (78.5%). Non-technical peri-procedural hemorrhage occurred in 5 cases, transient neurological deficit in 13 cases, persistent neurological deficit in 9 cases, and death in one case. There was no significant difference in complications between patients with and without complete embolization. By univariate analyses, small size (≤ 3 cm), single feeding artery, double feeding artery, terminal feeders, single drainage vein, and superficial venous drainage were associated with cure by embolization (P < 0.05). Single drainage vein (P = 0.003) and 1–2 feeding arteries (P = 0.009) were correlated with AVM volume reduction in the multivariate model.
Conclusions: Initial Onyx-18 embolization for sbAVMs can achieve satisfactory outcomes. Curative embolization can be achieved in the initial single session with low morbidity, and it is not correlated with complications. A single draining vein and 1–2 arterial feeders could be predictive for curative embolization.
