Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations

Aaron Rodriguez-Calienes; Juan Vivanco-Suarez; Matias Costa; Johssy Yelma Echevarria-Quispe; Rodolfo Rodríguez-Varela; Santiago Ortega-Gutierrez; Giancarlo Saal-Zapata

doi:10.1016/j.jstrokecerebrovasdis.2023.107137

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Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations

Journal article

Peer reviewed

Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations

Aaron Rodriguez-Calienes, Juan Vivanco-Suarez, Matias Costa, Johssy Yelma Echevarria-Quispe, Rodolfo Rodríguez-Varela, Santiago Ortega-Gutierrez and Giancarlo Saal-Zapata

Journal of stroke and cerebrovascular diseases, Vol.32(6), 107137

06/01/2023

DOI: 10.1016/j.jstrokecerebrovasdis.2023.107137

PMID: 37068327

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Abstract

We evaluated the safety and efficacy of endovascular embolization as first-line stand-alone strategy for the treatment of low-grade brain arteriovenous malformations (bAVMs) (Spetzler Martin [SM] grade I and II) in pediatric patients. In addition, we assessed the predictors of procedure-related complications and radiographic complete obliteration in a single session. We conducted a single center retrospective cohort study of all pediatric (≤18 years) patients who underwent embolization as a stand-alone strategy for low-grade bAVMs between 2010 and 2022. Safety was measured by procedure-related complications and mortality. Efficacy was defined as complete angiographic obliteration after the last embolization session. Sixty-eight patients (41 females; median age 14 years) underwent a total of 102 embolization sessions. There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Six procedure-related complications (5.8% of procedures) were observed and no deaths were reported. All the complications were intraoperative nidus ruptures. A single draining vein was the only significant predictor of procedure-related complications (OR=0.10; 95% CI 0.01 - 0.72; p=0.048). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (51%) the bAVM was completely occluded in one session. The bAVM nidal size was a predictor of complete obliteration in one session (OR=0.44; 95% CI, 0.21-0.80; p=0.017). Endovascular treatment as a stand-alone strategy for pediatric low-grade bAVMs is an adequate first-line approach in high volume centers with endovascular expertise. Nidal size evaluation is relevant in order to optimize patient selection for embolization as a stand-alone treatment modality.

Stroke

Arteriovenous malformations

Embolization

Pediatric

Details

Title: Subtitle: Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations
Creators: Aaron Rodriguez-Calienes
Juan Vivanco-Suarez - University of Iowa
Matias Costa - Cerebrovascular Neurosurgery Department, Swedish Neuroscience Institute, Seattle, WA, USA
Johssy Yelma Echevarria-Quispe - Universidad Científica del Sur
Rodolfo Rodríguez-Varela
Santiago Ortega-Gutierrez
Giancarlo Saal-Zapata
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.32(6), 107137
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107137
PMID: 37068327
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Grant note: DOI: 10.13039/100000065, name: National Institute of Neurological Disorders and Stroke
Language: English
Date published: 06/01/2023
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984398211302771

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