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Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO)

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Abstract

Objectives

To evaluate the safety and efficacy of a new liquid embolic agent in brain arteriovenous malformation (bAVMs) embolisation.

Methods

A prospective, multicentre series was conducted at 11 interventional centres in Europe to evaluate embolisation of bAVMs with the new liquid embolic agent. Technical conditions, complications, clinical outcome and anatomical results were independently analysed.

Results

From December 2005 to December 2008, 117 patients (72 male; 45 female, aged 18–75 years) were included. Clinical presentation was mostly haemorrhage (34.2 %) and seizures (28.2 %). Most AVMs were located in the brain hemispheres (85.5 %). AVMs were <3 cm in 52.1 % of patients and ≥3 cm in 47.9 %. Morbidity was observed in 6/117 patients (5.1 %), related to haemorrhagic events in 2 cases and non-haemorrhagic complications in 4 cases. Five patients (4.3 %) died in relation to the treatment (bleeding in 4 patients and extensive venous thrombosis in 1). Complete occlusion of the AVM by embolisation alone was obtained in 23.5 % of patients. Complementary treatment was performed in 82.3 % of patients with partial AVM occlusion, mostly radiosurgery.

Conclusions

In this prospective, multicentre, European, observational series, the new liquid embolic agent proved to be suitable for BAVM embolisation, with acceptable morbidity and mortality and good efficacy.

Key Points

• Numerous interventional techniques have been used to embolise brain arteriovenous malformations (AVMs).

• This prospective multicentre study demonstrates the suitability of a liquid embolic agent.

• The safety of treatment using Onyx is acceptable.

• Such embolisation leads to complete AVM occlusion in 23.5 % of patients.

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Abbreviations

bAVM:

Brain arteriovenous malformations

DMSO:

Di-methyl-sulphoxide

DSA:

Digital subtraction angiography

NBCA:

N-butyl-cyanoacrylate

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Acknowledgements

This registry was financially supported by Covidien/ev3 France.

L. Pierot is consultant to Covidien/ev3 France.

Author information

Authors and Affiliations

  1. Department of Radiology, Hôpital Maison-Blanche, Reims, France

    L. Pierot

  2. Department of Neuroradiology, Hôpital Purpan, Toulouse, France

    C. Cognard

  3. Department of Neuroradiology, Hôpital Bretonneau, Tours, France

    D. Herbreteau

  4. Department of Neuroradiology, AZ Sint Lukas and Volkskliniek, Gent, Belgium

    H. Fransen

  5. Department of Neuroradiology, Elisabeth Ziekenhuis, Tilburg, The Netherlands

    W. J. van Rooij

  6. Department of Neuroradiology, A.O. Niguarda Ca’ Granda, Milano, Italy

    E. Boccardi

  7. Department of Neuroradiology, A.O. Istituti Ospitalieri di Verona, Verona, Italy

    A. Beltramello

  8. Department of Neuroradiology, Hôpital La Pitié-Salpétrière, Paris, France

    N. Sourour & A. Biondi

  9. Department of Neuroradiology, Riga Hospital, Riga, Latvia

    K. Kupcs

  10. Department of Neuroradiology, CHU Montpellier, Hôpital Gui de Chauliac, Montpellier, France

    A. Bonafé

  11. Department of Neuroradiology, Universitätsklinikum des Saarlandes, Homburg, Germany

    W. Reith

  12. Endovascular and Percutaneous Therapy Service, Hospital Nuestra Senora del Rosario, Madrid, Spain

    A. Casasco

  13. Service de Radiologie, Hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092, REIMS cedex, France

    L. Pierot

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  1. L. Pierot
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  2. C. Cognard
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  3. D. Herbreteau
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  5. W. J. van Rooij
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  6. E. Boccardi
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  7. A. Beltramello
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  8. N. Sourour
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Corresponding author

Correspondence to L. Pierot.

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Pierot, L., Cognard, C., Herbreteau, D. et al. Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO). Eur Radiol 23, 2838–2845 (2013). https://doi.org/10.1007/s00330-013-2870-6

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  • DOI: https://doi.org/10.1007/s00330-013-2870-6

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