Application of a Novel Brain Arteriovenous Malformation Endovascular Grading Scale for Transarterial Embolization

Bell, Donnie; Leslie‐Mazwi, Thabele M; Yoo, A; Rabinov, James D.; Butler, William E.; Bell, J.E.; Hirsch, Joshua A

doi:10.3174/ajnr.a4286

Cited by 15 publications

(4 citation statements)

References 30 publications

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“…The Lawton-Young Grading System improves the outcome prediction accuracy and is a feasible alternative to the SM system [22]. Recently, several grading systems for procedural risk in the EVT of BAVMs have been proposed, including the Buffalo, Puerto Rico, and BAVM embocure scoring systems [23][24][25][26][27]. However, these scoring systems are simply based on the number of feeders, AVM size, eloquence, and venous drainage.…”

Section: Discussionmentioning

confidence: 99%

Brain arteriovenous malformations of the middle cerebral artery region: image characteristics and endovascular treatment based on a new classification system

2023

BMC Neurol

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Background To date, few studies have investigated the use of endovascular treatment (EVT) for brain arteriovenous malformations (BAVMs) in the supplying area of the middle cerebral artery (MCA). Moreover, no suitable classification was aimed at EVT for MCA-BAVMs. Therefore, this study proposed a new classification. Methods This study retrospectively collected 135 MCA‑BAVMs. They were classified into four types: Type I BAVMs located above the M1 segment; Type II BAVMs located in the region around the Sylvian fissure; and Type III BAVMs located in the supplying region of the M4 segment and subdivided into types IIIa and IIIb. The relevance of various types of MCA-BAVMs and their imaging characteristics and EVT outcomes was analyzed by ordinary one-way ANOVA, Tukey's multiple comparisons test and the chi-square test. Results The 135 patients averaged 33.8 ± 14.7 years and included 75 females (55.6%, 75/135). Among them, 15 (11.1%, 15/135), 16 (11.9%, 16/135), 54 (40%, 54/135), and 50 (37%, 50/135) MCA-BAVMs were type I, II, IIIa and IIIb, respectively. After EVT, a good outcome was achieved in 97% of patients. Statistical analysis showed that type I BAVMs were smaller than type II and IIIb BAVMs (P value < 0.05), and type IIIb BAVMs were larger than type I and IIIa BAVMs (P value < 0.05). Deep vein involvement in type I and IIIb BAVMs was more common than in other types (P value < 0.05), and intraventricular hemorrhage (IVH) was also more common (P value < 0.05). The normal morphology in type IIIb was less than that in the other types (P value < 0.05). Type IIIa BAVMs had a higher degree than other types (P value < 0.05). Conclusion The present study demonstrated that the new classification of MCA-BAVMs can be used to evaluate imaging characteristics and EVT outcomes in different types. In addition, EVT may be a safe treatment modality for MCA‑BAVMs.

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Section: Discussionmentioning

confidence: 99%

Brain arteriovenous malformations of the middle cerebral artery region: image characteristics and endovascular treatment based on a new classification system

2023

BMC Neurol

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“…25 In the pre-Onyx era, endovascular treatment for bAVMs was deemed to carry a procedural risk related to the Spetzler-Martin grade, number of embolizations treated, and the patient characteristics (increased age and absence of pretreatment neurologic deficits). 26,27 After the introduction of Onyx for AVM embolizations, Bell et al 25 reported their experience of transarterial embolization in 126 patients with bAVMs and concluded that procedure-related complications did not correlate with the Spetzler-Martin grade, but with a novel endovascular grading scale incorporating the number of feeding arteries, eloquence, and the presence of an arteriovenous fistula component. Pan et al 19 categorized complications of AVM embolization using liquid materials into technique-related and non-technique-related.…”

Section: Discussionmentioning

confidence: 99%

Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance

Sato

Matsumoto

Tominaga

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Embolization is widely performed to treat brain arteriovenous malformations, but little has been reported on factors contributing to complications. We retrospectively reviewed a nationwide surveillance to identify risk factors contributing to complications and short-term clinical outcomes in the endovascular treatment of brain arteriovenous malformations. MATERIALS AND METHODS: Data for endovascular treatment of brain arteriovenous malformations were extracted from the Japanese nationwide surveillance. Patient characteristics, brain arteriovenous malformation features, procedures, angiographic results, complications, and clinical outcomes at 30 days postprocedure were analyzed.

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“…An embolization-related morbidity rate of 3.7% was noted and there were no procedural mortalities. An embolization grading scale that incorporates the number of feeding arteries, eloquence, and the presence of fistulas within the AVM nidus has also been developed to predict endovascular or multimodality cure based on a single large institution experience 49. At present, the optimal timing of embolization before surgery is unclear as is the optimal embolic agent 50…”

Section: Endovascular Embolization Of Brain Avmsmentioning

confidence: 99%

Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Leacy

Ansari

Schirmer

et al. 2022

J NeuroIntervent Surg

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BackgroundThe purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMsMethodsWe performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors.ResultsThe multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)—including 2D, 3D, and reformatted cross-sectional views when appropriate—is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR). (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR). (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR). (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD). (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD). (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR). (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD). (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD). (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO).ConclusionsAlthough the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.

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Application of a Novel Brain Arteriovenous Malformation Endovascular Grading Scale for Transarterial Embolization

Cited by 15 publications

References 30 publications

Brain arteriovenous malformations of the middle cerebral artery region: image characteristics and endovascular treatment based on a new classification system

Brain arteriovenous malformations of the middle cerebral artery region: image characteristics and endovascular treatment based on a new classification system

Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance

Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

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