Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations

Willinsky, Robert A.; Fitzgerald, M. J. T.; terBrugge, Karel G.; Montanera, Walter; Wallace, M. Christopher

doi:10.1007/bf00602622

Cited by 28 publications

(12 citation statements)

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“…There have been two reports of re-canalization of spontaneously regressed cerebral AVMs [3,25] and a report of temporary angiographic non-visualization of a small cerebral AVM [26].…”

Section: Hypotheses For Spontaneous Regression Of the Cerebral Arterimentioning

confidence: 99%

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

et al. 2002

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Spontaneous regression of cerebral arteriovenous malformation (AVM) is rare and poorly understood. We reviewed the clinical and angiographic findings in patients who had spontaneous regression of cerebral AVMs to determine whether common features were present. The clinical and angiographic findings of four cases from our series and 29 cases from the literature were retrospectively reviewed. The clinical and angiographic features analyzed were: age at diagnosis, initial presentation, venous drainage pattern, number of draining veins, location of the AVM, number of arterial feeders, clinical events during the interval period to thrombosis, and interval period to spontaneous thrombosis. Common clinical and angiographic features of spontaneous regression of cerebral AVMs are: intracranial hemorrhage as an initial presentation, small AVMs, and a single draining vein. Spontaneous regression of cerebral AVMs can not be predicted by clinical or angiographic features, therefore it should not be considered as an option in cerebral AVM management, despite its proven occurrence.

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“…There have been two reports of re-canalization of spontaneously regressed cerebral AVMs [3,25] and a report of temporary angiographic non-visualization of a small cerebral AVM [26].…”

Section: Hypotheses For Spontaneous Regression Of the Cerebral Arterimentioning

confidence: 99%

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

et al. 2002

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“…Whereas MRI may throw further light on the cause of haemorrhage within the "primary" group, there is as yet no evidence to suggest that it would be as sensitive as angiography in the detection of arteriovenous malformation. 33 Willinsky et al state that very small arteriovenous malformations are, by their nature, occult on MRI." In one of our patients, MRI did not detect a small arteriovenous malformation, but MRA was not performed.…”

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confidence: 99%

Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma.

Halpin

Britton

Byrne

et al. 1994

Journal of Neurology, Neurosurgery & Psychiatry

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One hundred and two consecutive patients with cerebral haematoma were prospectively allocated to one of two groups according to their CT on admission. Group 1 patients were thought to have a high probability of an underlying structural lesion and underwent cerebral angiography acutely. If normal, this was repeated at three months. Group 2 patients were thought not to have such a lesion and underwent angiography at three months. Patients older than the mean age of the study population, and hypertensive patients were much less likely to harbour an aneurysm or arteriovenous malformation than younger or normotensive patients (p < 0-01; sensitivity 87-9%, specificity 88.6%). An aneurysm or arteriovenous malformation was the cause of haemorrhage in 12-8% of hypertensive patients, in 309% of patients with haematoma involving the basal ganglia, and 18-2% of those with posterior fossa haemorrhage. Features of CT in isolation give a sensitivity of 77-2% and a specificity of 84-2%. Follow up angiography in group 1 showed an arteriovenous malformation in one of seven patients in whom the original study was normal. These results contrast sharply with data from previous retrospective studies. The decision to investigate a patient with cerebral haematoma should be primarily based on the patient's clinical condition, rather than on the site of haemorrhage. (7 Neurol Neurosurg Psychiatry 1994;57: 1180-1186 Stroke is caused by spontaneous cerebral haemorrhage in 4% to 119% of patients"2 although rates of up to 40% have been quoted.3 Acute mortality ranges from 18°% to 75%, depending on the size and position of the haematoma and the age and clinical condition of the patient.'45 To prevent recurrence, it is important to identify patients in whom haemorrhage is secondary to an underlying structural lesion, such as an aneurysm, vascular malformation, or tumour. Pathological studies have indicated that primary haemorrhage is most likely to occur in certain sites-in particular the basal ganglia and posterior fossa.6 Factors such as -age, pre-existing systemic hypertension, and haematoma location are commonly employed in selecting patients for angiography. The influence of clinical features and CT on final diagnosis has been described retrospectively,7-" but to our knowledge there has been no prospective angiographic assessment in life of the relative frequency of primary and secondary haemorrhage in patients with cerebral haematoma. MethodsAll patients presenting consecutively to this hospital between 1989 and 1992 with spontaneous cerebral haematoma were entered into the study. They were assigned to one of two groups after evaluation of their CT on admission by two or three consultant neuroradiologists. If the haematoma was thought likely to be due to an underlying structural cause, angiography was carried out as soon as the patient's condition allowed, and was repeated three months later if negative (group 1). If, however, such a lesion was not suspected, angiography was delayed by three months (group 2).The radiologists were...

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“…The majority of these cryptic vascular malformations are arteriovenous malformations (AVMs) 1,3,4,9,22,23 that are less than 3 cm in size. Possibly due to their small size, partial or complete thrombosis, obliteration by hematoma, or high vascular resistance of the vascular component, the usual selective four-vessel angiographic investigation is often negative for shunting or early venous filling 7.…”

Section: Introductionmentioning

confidence: 99%

Role of Superselective Angiography in the Detection and Endovascular Treatment of Ruptured Occult Arteriovenous Malformations

Tanaka

Valavanis

2001

Interv Neuroradiol

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Three cases of occult micro-arteriovenous malformations not identified by cerebral angiography or other imaging modalities were detected by superselective angiography. The first case had a small intracerebral hemorrhage in the superior colliculus, the second had a perimesencephalic subarachnoid hemorrhage, and the third presented with intracerebral hemorrhage combined with massive intraventricular hematoma. While repeated selective cerebral angiography (four-vessel study) was negative, superselective angiography clearly demonstrated each lesion with small early venous filling in accordance with the location of hematoma. Successful superselective embolization with polyvinyl alcohol particles was performed in each micro-arteriovenous malformation by flow-guided microcatheter without postoperative complications. Our experience suggests that superselective angiography is necessary to visualize micro-arteriovenous malformations in patients with cerebral hemorrhage and negative four-vessel angiography. Furthermore, the superselective endovascular approach has the advantage of offering immediate obliteration of the micro-shunt, thereby reducing or eliminating the risk of further hemorrhage.

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Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations

Cited by 28 publications

References 14 publications

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma.

Role of Superselective Angiography in the Detection and Endovascular Treatment of Ruptured Occult Arteriovenous Malformations

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