Adjuvant embolization with n-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations: Outcomes, complications, and predictors of neurologic deficits

Robert M. Starke, Ricardo J Komotar, Marc L. Otten, David K. Hahn, Laura E. Fischer, Brian Y. Hwang, Matthew C. Garrett, Robert R. Sciacca, Michael B. Sisti, Robert A. Solomon, Sean D. Lavine, E. Sander Connolly, Philip M. Meyers

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE-: The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. METHODS-: From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (n=176) or radiosurgery (n=26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4±34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale ≤2), or significant (modified Rankin Scale >2). RESULTS-: Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (P<0.0001). Five patients had persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95% CI, 1.4 to 8.6), diameter <3 cm (OR, 3.2; 95% CI, 1.2 to 9.1), diameter >6 cm (OR, 6.2; 95% CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95% CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95% CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (P<0.0001). CONCLUSIONS-: Small and large size, eloquent location, deep venous drainage, and complex vascular anatomy requiring multiple embolization procedures are risk factors for the development of immediate postembolization neurological deficits. Nevertheless, a significant number of patients with treatment-related neurological deficits improve over time. The low incidence of permanent neurological deficits underscores the usefulness of this technique in carefully selected patients.

Original languageEnglish
Pages (from-to)2783-2790
Number of pages8
JournalStroke
Volume40
Issue number8
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

Fingerprint

Cyanoacrylates
Intracranial Arteriovenous Malformations
Neurologic Manifestations
Arteriovenous Malformations
Therapeutics
Drainage
Microsurgery
Radiosurgery
Blood Vessels
Anatomy
Incidence

Keywords

  • Arteriovenous malformation
  • Complication
  • Embolization
  • Outcome
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Adjuvant embolization with n-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations : Outcomes, complications, and predictors of neurologic deficits. / Starke, Robert M.; Komotar, Ricardo J; Otten, Marc L.; Hahn, David K.; Fischer, Laura E.; Hwang, Brian Y.; Garrett, Matthew C.; Sciacca, Robert R.; Sisti, Michael B.; Solomon, Robert A.; Lavine, Sean D.; Connolly, E. Sander; Meyers, Philip M.

In: Stroke, Vol. 40, No. 8, 01.08.2009, p. 2783-2790.

Research output: Contribution to journalArticle

Starke, RM, Komotar, RJ, Otten, ML, Hahn, DK, Fischer, LE, Hwang, BY, Garrett, MC, Sciacca, RR, Sisti, MB, Solomon, RA, Lavine, SD, Connolly, ES & Meyers, PM 2009, 'Adjuvant embolization with n-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations: Outcomes, complications, and predictors of neurologic deficits', Stroke, vol. 40, no. 8, pp. 2783-2790. https://doi.org/10.1161/STROKEAHA.108.539775
Starke, Robert M. ; Komotar, Ricardo J ; Otten, Marc L. ; Hahn, David K. ; Fischer, Laura E. ; Hwang, Brian Y. ; Garrett, Matthew C. ; Sciacca, Robert R. ; Sisti, Michael B. ; Solomon, Robert A. ; Lavine, Sean D. ; Connolly, E. Sander ; Meyers, Philip M. / Adjuvant embolization with n-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations : Outcomes, complications, and predictors of neurologic deficits. In: Stroke. 2009 ; Vol. 40, No. 8. pp. 2783-2790.
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abstract = "BACKGROUND AND PURPOSE-: The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. METHODS-: From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (n=176) or radiosurgery (n=26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4±34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale ≤2), or significant (modified Rankin Scale >2). RESULTS-: Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8{\%} of procedures; 14{\%} of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (P<0.0001). Five patients had persistent neurological deficits due to embolization (1.3{\%} of procedures; 2.5{\%} of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95{\%} CI, 1.4 to 8.6), diameter <3 cm (OR, 3.2; 95{\%} CI, 1.2 to 9.1), diameter >6 cm (OR, 6.2; 95{\%} CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95{\%} CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95{\%} CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6{\%}, a score of 2 predicted a new deficit rate of 15{\%}, a score of 3 predicted a new deficit rate of 21{\%}, and a score of 4 predicted a new deficit rate of 50{\%} (P<0.0001). CONCLUSIONS-: Small and large size, eloquent location, deep venous drainage, and complex vascular anatomy requiring multiple embolization procedures are risk factors for the development of immediate postembolization neurological deficits. Nevertheless, a significant number of patients with treatment-related neurological deficits improve over time. The low incidence of permanent neurological deficits underscores the usefulness of this technique in carefully selected patients.",
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TY - JOUR

T1 - Adjuvant embolization with n-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations

T2 - Outcomes, complications, and predictors of neurologic deficits

AU - Starke, Robert M.

AU - Komotar, Ricardo J

AU - Otten, Marc L.

AU - Hahn, David K.

AU - Fischer, Laura E.

AU - Hwang, Brian Y.

AU - Garrett, Matthew C.

AU - Sciacca, Robert R.

AU - Sisti, Michael B.

AU - Solomon, Robert A.

AU - Lavine, Sean D.

AU - Connolly, E. Sander

AU - Meyers, Philip M.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - BACKGROUND AND PURPOSE-: The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. METHODS-: From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (n=176) or radiosurgery (n=26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4±34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale ≤2), or significant (modified Rankin Scale >2). RESULTS-: Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (P<0.0001). Five patients had persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95% CI, 1.4 to 8.6), diameter <3 cm (OR, 3.2; 95% CI, 1.2 to 9.1), diameter >6 cm (OR, 6.2; 95% CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95% CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95% CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (P<0.0001). CONCLUSIONS-: Small and large size, eloquent location, deep venous drainage, and complex vascular anatomy requiring multiple embolization procedures are risk factors for the development of immediate postembolization neurological deficits. Nevertheless, a significant number of patients with treatment-related neurological deficits improve over time. The low incidence of permanent neurological deficits underscores the usefulness of this technique in carefully selected patients.

AB - BACKGROUND AND PURPOSE-: The purpose of this study was to assess the frequency, severity, and predictors of neurological deficits after adjuvant embolization for cerebral arteriovenous malformations. METHODS-: From 1997 to 2006, 202 of 275 patients with arteriovenous malformation received embolization before microsurgery (n=176) or radiosurgery (n=26). Patients were examined before and after endovascular embolization and at clinical follow-up (mean, 43.4±34.6 months). Outcome was classified according to the modified Rankin Scale. New neurological deficits after embolization were defined as minimal (no change in overall modified Rankin Scale), moderate (modified Rankin Scale ≤2), or significant (modified Rankin Scale >2). RESULTS-: Two hundred two patients were treated in 377 embolization procedures. There were a total of 29 new clinical deficits after embolization (8% of procedures; 14% of patients), of which 19 were moderate or significant. Postembolization deficits resolved in a significant number of patients over time (P<0.0001). Five patients had persistent neurological deficits due to embolization (1.3% of procedures; 2.5% of patients). In multivariate analysis, the following variables significantly predicted new neurological deficit after embolization: complex arteriovenous malformation with treatment plan specifying more than one embolization procedure (OR, 2.7; 95% CI, 1.4 to 8.6), diameter <3 cm (OR, 3.2; 95% CI, 1.2 to 9.1), diameter >6 cm (OR, 6.2; 95% CI, 1.0 to 57.0), deep venous drainage (OR, 2.7; 95% CI, 1.1 to 6.9), or eloquent location (OR, 2.4; 95% CI, 1.0 to 5.7). These variables were weighted and used to compute an arteriovenous malformation Embolization Prognostic Risk Score for each patient. A score of 0 predicted no new deficits, a score of 1 predicted a new deficit rate of 6%, a score of 2 predicted a new deficit rate of 15%, a score of 3 predicted a new deficit rate of 21%, and a score of 4 predicted a new deficit rate of 50% (P<0.0001). CONCLUSIONS-: Small and large size, eloquent location, deep venous drainage, and complex vascular anatomy requiring multiple embolization procedures are risk factors for the development of immediate postembolization neurological deficits. Nevertheless, a significant number of patients with treatment-related neurological deficits improve over time. The low incidence of permanent neurological deficits underscores the usefulness of this technique in carefully selected patients.

KW - Arteriovenous malformation

KW - Complication

KW - Embolization

KW - Outcome

KW - Surgery

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