| Background and PurposeIntracranial arteriovenous malformations(AVMs)are congenital diseases with abnormal cerebrovascular formation in the embryonic stage,which occur frequently in youths.At present,there is no unified treatment strategy for AVMs.Traditional treatment methods include stereotactic radiosurgery,surgical craniotomy,transarterial endovascular embolization and their combination.The traditional treatment strategies for AVMs with Spetzler-Martin I or II are still acceptable,but there are still some shortcomings.Some AVMs with multiple,tortuous and slender feeding arteries,deep location,have a low cure rate in traditional methods,and it is difficult to achieve satisfactory results.In recent years,transvenous endovascular embolization(TVE)technique,as a new strategy for the treatment of AVMs,has solved the problems of traditional treatment methods.The treatment mechanism is to reduce blood flow velocity and volume into the nidus,make the embolic agent transvenous retrograde permeation,and make the nidus thrombosis,so as to achieve the curative embolism of AVMs.At present,the study of this technique is still in its infancy,and related studies abroad have confirmed that transvenous embolization of intracranial arteriovenous malformations seems safe and effective.Literature reports on the TVE technique are few in China,most of which are reported by our center.The aim of this study was to evaluate the safety and efficacy of transvenous endovascular embolization in the treatment of ruptured intracranial arteriovenous malformations in China.MethodsThis study prospectively recruit patients with intracranial arteriovenous malformations treated with TVE technique in the Department of Intracranial Arteriovenous Malformations,Zhengzhou University People’s Hospital from November 2016 to December 2018.The baseline and clinical data were collected.A total of 21 patients(21 arteriovenous malformations)were included.The baseline data and follow-up data were recorded in detail.Clinical follow-up was achieve at 1,3,6,12,24,36 months after operation,and the prognosis was evaluated by m RS score.The imaging follow-up were performed at 6,12,24 and 36 months after operation,to evaluate the efficacy of TVE technique.Relevant statistical methods were used to analyze the related factors affecting nidus occlusion and complications.Results1.A total of 21 patients(21 arteriovenous malformations)were enrolled.The success rate of the technique was 90.5%.A total of 34 operations were performed,including 21 intravenous embolization,8 transarterial embolization,3 Surgical craniotomy and 2 radiosurgery.Among the 19 patients with successful technique,6cases passed through superior sagittal sinus,9 cases through straight sinus and 4 cases through transverse sinus.There were 6 cases using coils,3 cases using liquid embolic agents,4 cases using balloon alone,4 cases using liquid embolic agents combined with balloon,1 case using coils plus embolic agents,and 1 case using coils,balloons and embolic agents.2.15 patients acquired imaging follow-up,the median follow-up time was 5 months(2-15 months),of which 14(93.3%,14/15)patients had complete occlusion and no recurrence of nidus.One patient in whom immediate angiographic occlusion was not achieved showed spontaneous occlusion at the 13-month follow-up.Twenty-one patients have the clinical follow-up,median follow-up time was 15.5 months(2-26months).Nineteen patients(90.5%,19/21)had the m RS score less than 2.3.Severe complications that caused death and disability occurred in 2(9.5%,2/21)patients.One patient had ventricular hemorrhage confirmed by CT on 3rd day after operation,and another patient had brain edema and cerebral infarction after operation.Conclusion1.The follow-up results of this study show that the cure rate of ruptured intracranial arteriovenous malformations treated by TVE technique is significantly improved during the mid-term follow-up,and no recurrence of nidus is observed during the follow-up period.2.The follow-up results of this study show that the safety of ruptured intracranial arteriovenous malformations treated by TVE technique needs to be improved and Confirmed with large sample data. |
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