| Objective To explore the effectiveness and safety of vascular intervention in the treatment of intracranial arteriovenous malformations complicated with blood flow related aneurysms,to study the risk factors of cavm-fa rupture and bleeding,and to seek a safer treatment strategy.Methods In this study,we retrospectively analyzed the clinical data of patients with cerebral arteriovenous malformations treated with vascular intervention in the Department of Neurosurgery of Zhujiang Hospital of Southern Medical University from January 2011 to June 2019.By comparing the clinical characteristics of patients with cerebral arteriovenous malformation complicated with blood flow related aneurysms(CAVM-FA)compared with patients with simple CAVM,this paper summarizes the clinical characteristics of CAVM,and explores the clinical efficacy of intravascular interventional therapy on cerebral arteriovenous malformation complicated with blood flow related aneurysms.At the same time,through subgroup analysis,we statistically evaluated the risk of aneurysmal bleeding and abnormal rupture bleeding,in order to guide safer treatment.Results In this study,we included a total of 685 patients,including 596 patients with simple CAVM and 89 patients with CAVM-FA.The average age of patients in CAVM-FA group was higher than that in CAVM alone group(45.9±16.8 vs 33.7±17.1,P=0.000),and there was no significant difference in gender(P=0.466).There was no significant difference in preoperative mRS score and the proportion of rupture and bleeding between the two groups(P=0.894;P=0.370).Among these patients,the most common clinical symptoms were bleeding(41.8%),headache(50.7%)and epilepsy(21.5%).There was no significant difference in the proportion of bleeding,headache,epilepsy,neurological impairment and asymptomatic patients between the two groups(P=0.467;P=0.343;P=0.072;P=0.526;P=0.224).There was no significant difference in SM grade,maximum diameter,location,functional area and deep venous drainage between the two groups(P=0.322,P=0.513,P=0.479).The distribution of SM grade was similar between the two groups(P=0.120),and the patients were mainly grade Ⅱ and Ⅲ patients.There were 106 FAs in 89 patients with CAVM-FA,mainly distributed in anterior cerebral artery and middle cerebral artery,of which 62(58.5%)were ruptured IA and 44(41.5%)were un-ruptured IA;There were 72(80.9%)patients with single IA and 17(19.1%)with multiple IA.A total of 100 FA underwent coiling and 6 FA underwent stent-assisted coiling.There was a significant difference between interventional embolization alone and interventional embolization combined with gamma knife treatment.The results showed that the number of patients treated with interventional therapy alone was lower and the proportion of patients treated with interventional combined with radiotherapy was higher in CAVM-FA group(P=0.009).During an average follow-up of 18.6±14.2 months,a total of 279(40.7%)met the imaging criteria of complete/sub-total occlusion,and 17 recurred after complete embolization(2.5%).Although the risk of epilepsy(P=0.007)and neurological injury(P=0.005)increased after interventional embolization,there was no significant difference in the rate of complete occlusion and the risk of recurrence between the two groups.In the subgroup analysis of risk factors for CAVM-FA bleeding,higher age and smaller abnormal volume were significantly associated with aneurysm rupture in patients with CAVM-FA(P=0.029 and P=0.001).The malformation located in the functional area was associated with non-hemorrhagic manifestations(P=0.032).The location of CAVM in cerebellar peduncle was also significantly correlated with aneurysm rupture(P=0.040).Conclusion Intravascular interventional therapy is a main.treatment for CAVM-FA patients.It can also be used as an adjuvant treatment of craniotomy and gamma knife treatment.It has the advantages of less trauma,low postoperative complications and low risk of postoperative recurrence.During treatment,priority should be given to identifying and embolizing the responsible lesions.If the responsible lesions are unknown,priority should be given to embolizing aneurysms with high risk of rupture and bleeding,or embolizing.aneurysms and abnormal lesions at the same time.More accurate research results need high-quality multicenter prospective research.. |
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