POSTEMBOLIZATION NEUROLOGICAL DEFICITS IN CEREBRAL ARTERIOVENOUS MALFORMATIONS: STRATIFICATION BY ARTERIOVENOUS MALFORMATION GRADE

Abstract

OBJECTIVE

To stratify the risk of embolization during the treatment of cerebral arteriovenous malformations (AVMs) by grade and to assess its impact on overall treatment risk.

METHODS

Patients with cerebral AVMs treated with embolization between 1995 and 2004 were reviewed retrospectively. Age, sex, AVM grade, location of lesion, number and location of embolized arteries, and number of embolization sessions were analyzed with respect to neurological or vascular complications after embolization.

RESULTS

Embolization was performed in 153 patients: 508 vessels were embolized over 203 sessions (mean, 3.3 vessels/patient). Mean angiographic and clinical follow-up was 1.7 and 2.1 years, respectively (range, 3 to 60 mo). The periprocedural morbidity and mortality rate was 11.8% but at last follow-up only 2% of survivors were significantly disabled (modified Rankin›2). One patient died (0.7%), and 17 patients suffered unexpected neurological deficits immediately after embolization. Five of these patients demonstrated near or total recovery during follow-up. The number of branches embolized was the only variable significantly related to neurological deficit (P›0.017). The long-term rates of neurological deficits after embolization were 0%, 5%, 7%, 10%, and 18%, respectively, for AVM grades I through V. Among 114 patients who underwent preoperative embolization, follow-up deficit rates of Grade I through V were 0%, 5%, 6%, 6%, and 25%, respectively. Long-term permanent deficits from embolization occurred in 8.6%.

CONCLUSION

Endovascular treatment carries a procedural risk related to AVM grade and number of branches treated. This risk should be weighed carefully in the context of overall treatment morbidity/mortality.

Arteriovenous malformation, Complications, Embolization, Endovascular treatment, Morbidity, Surgical treatment