Successful endovascular treatment of low grade Brain AVMs
EANS Academy. Puthuran M. 09/27/19; 276160; EP01097
Mani Puthuran
Mani Puthuran

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Aim: To demonstrate that lower grade brain AVMs can be successfully treated with endovascular embolisation. Brain arteriovenous malformation is a complex disease associated with significant morbidity and mortality. A European consensus document concluded that balancing the risk of haemorrhage and the associated restriction to activities related to untreated uAVMs against the risk of treatment, consideration should be made to treat grade 1 and 2 SM unruptured AVMs .
Method: 43 patients were treated over 4 years. Male: M:F - 1:1.7, Age range 13 days to 79 years. Primary aim of treatment was for complete occlusion with embolisation. After a superselective angiogram was performed, a decision was made on the feasibility of endovascular treatment for complete eradication of the brain AVM. Embolisation was performed with liquid embolic agents. All cases were performed using detachable microcatheters.
Results: Of the 43 patients treated with goal of eradication of AVM with embolisation alone, complete occlusion was achieved in 94%. One patient is awaiting 2nd stage embolisation and another patient is awaiting follow-up angiogram. In one patient venous penetration was not achieved and was referred for radiosurgery. Procedural complications; procedural bleeds in three patients, of which one patient had clinical consequences ending with an mRS of 2. No death or significant morbidity was observed.
Conclusion: Endovascular occlusion has been performed at our centre for the last 20 years with initial success to achieve complete occlusion being around 5%. With the advent of newer techniques including venous approach, greater success has been achieved in the eradication of brain AVM with embolisation alone. In low-grade AVMs embolisation alone can safely achieve complete occlusion in greater than 90% of cases and should be considered as the first choice.
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