Journal article
Curative embolization of ruptured pediatric cerebral arteriovenous malformations
Clinical neurology and neurosurgery, Vol.227, 107663
02/28/2023
DOI: 10.1016/j.clineuro.2023.107663
PMID: 36868088
Abstract
Embolization with the intention to cure has not been well studied in ruptured arteriovenous malformations (AVMs). Furthermore, the role of primary curative embolization of pediatric AVMs is uncertain. Hence, we aimed to characterize the safety and efficacy of curative embolization of ruptured pediatric AVMs and assess predictors of obliteration and complications.
A retrospective analysis of all pediatric (≤18 years) patients who underwent curative embolization of ruptured AVMs was conducted in two institutions between 2010 and 2022. The efficacy (complete angiographic obliteration after the last embolization session), recurrence (radiological recurrence of the lesion after confirmed obliteration in follow-up imaging), and safety (procedure-related complications and mortality) of the procedure were evaluated.
Sixty-eight patients (38 females; mean age 12.4 ± 3.4 years) underwent a total of 109 embolization sessions. Median follow-up time was 18 months after embolization (ranged from 2 to 47 months). Complete angiographic obliteration was achieved in 42 patients (62%). In 30 patients (44%) the AVM was occluded with a single embolization session. Recurrence of a totally embolized lesion occurred in 9 patients (13%). Thirteen complications (11.9% of procedures) were observed, and no deaths were reported. A nidus size > 2 cm was the only independent predictor of complete obliteration (OR = 0.16; 95% CI 0.03 – 0.77; p = 0.030).
Embolization of pediatric ruptured AVMs with curative intent can achieve acceptable obliteration rates. However, recurrence after complete obliteration and procedure-related complications of curative embolization of these lesions cannot be ignored. Ruptured AVMs ≤ 2 cm are adequate to achieve complete obliteration with curative endovascular management.
•The incidence of ruptured AVMs has increased following the ARUBA trial.•The role of curative embolization in the pediatric population is controversial.•Embolization of pediatric ruptured AVMs achieved complete obliteration in 62%.•The complications rate was of 11.9% with no deaths.•Curative embolization was effective but complications were common.
Details
- Title: Subtitle
- Curative embolization of ruptured pediatric cerebral arteriovenous malformations
- Creators
- Aaron Rodriguez-Calienes - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAJuan Vivanco-Suarez - University of IowaNagheli Fernanda Borjas-Calderón - Universidad de San Martín de PorresFabian A. Chavez-Ecos - Saint Aloysius Gonzaga National UniversityDiego Edilberto Morales Fernández - Servicio de Neurocirugía, Hospital Nacional Arzobispo Loayza, Lima, PeruMarco Malaga - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAJuan E. Basilio Flores - Department of Neurosurgery, Hospital Nacional Daniel Alcides Carrion, Callao, PeruSantiago Ortega-Gutierrez - University of IowaGiancarlo Saal-Zapata - EsSALUD
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.227, 107663
- DOI
- 10.1016/j.clineuro.2023.107663
- PMID
- 36868088
- NLM abbreviation
- Clin Neurol Neurosurg
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Publisher
- Elsevier B.V
- Language
- English
- Date published
- 02/28/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984375349502771
Metrics
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