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Ruptured brain arteriovenous malformations associated with aneurysms: safety and efficacy of selective embolization in the acute phase of hemorrhage

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The impact of targeted embolization of ruptured cerebral arteriovenous malformation (AVM)-associated arterial aneurysms in the acute phase of bleeding is not well known. The objective of our study was to analyze the safety and efficacy of this treatment strategy with special emphasis on its protective effect against rebleeding.

Methods

From a prospective database, all patients presenting between December 2005 and March 2012 with a ruptured cerebral AVM associated with arterial aneurysms contiguous to the hemorrhage were selected. Hemorrhagic stroke severity and clinical outcome were measured using, respectively, Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) scores.

Results

Twenty-five patients with ruptured cerebral AVMs associated with 31 arterial aneurysms contiguous with the hemorrhage were included. In the first group of 17 patients, the mean time to treatment was 30.1 h, while in the second group with 1 patient in poor initial clinical conditions and 7 admitted 7 to 28 days after bleeding, it was 17 days. All arterial aneurysms were totally occluded. Four patients presented rebleeding before treatment (mean interval 9.6 days) and four had rebleeding after treatment (mean interval 8.25 months). At a mean follow-up of 56 months, 21 patients were alive (19 mRS ≤ 2, 2 mRS > 2). Three patients died 2 days, 9 days, and 2 months after bleeding and another died of rebleeding of her residual AVM 19 months after treatment. Treatment-related morbidity and mortality were, respectively, 4 and 0 %.

Conclusion

Selective embolization of arterial aneurysms associated with ruptured AVMs is a safe procedure and could lower the immediate risk of rebleeding.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the ethics committee of the Hospices Civils de Lyon and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients or their legal representatives gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospices Civils de Lyon, Université Claude Bernard, “Pierre Wertheimer”, 59, Boulevard Pinel, 69500, Lyon, France

    Francesco Signorelli, Isabelle Pelissou-Guyotat & Jacques Guyotat

  2. Department of Interventional Neuroradiology, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France

    Benjamin Gory, Roberto Riva & Francis Turjman

  3. Department of Intensive Care and Critical Care Unit, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France

    Frédéric Dailler

  4. Department of Experimental and Clinical Medicine, University “Magna Graecia”, Catanzaro, Italy

    Francesco Signorelli

Authors
  1. Francesco Signorelli
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  2. Benjamin Gory
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  3. Isabelle Pelissou-Guyotat
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  4. Jacques Guyotat
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  5. Roberto Riva
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  6. Frédéric Dailler
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  7. Francis Turjman
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Correspondence to Francesco Signorelli.

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Signorelli, F., Gory, B., Pelissou-Guyotat, I. et al. Ruptured brain arteriovenous malformations associated with aneurysms: safety and efficacy of selective embolization in the acute phase of hemorrhage. Neuroradiology 56, 763–769 (2014). https://doi.org/10.1007/s00234-014-1395-2

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  • DOI: https://doi.org/10.1007/s00234-014-1395-2

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