A study assessed the safety and efficacy of acutely targeted embolization of weak angiographic sites in burst brain arteriovenous malformations (bAVMs) against delayed therapy. It looked into the angioarchitecture alterations that occur after this procedure. The researchers looked back on a database of ruptured bAVMs that they had collected prospectively. The study comprised 316 patients with ruptured bAVMs who arrived at the hospital within 48 hours after developing ictus.
There were statistically significant differences in the survival curves for rupture. In individuals with linked aneurysms, deep venous anatomy, and a higher Spetzler-Martin grade, multivariate analyses substantially predicted lesser re-rupture in acute targeted treatment and higher re-rupture in those with associated aneurysms deep venous anatomy, and a higher Spetzler-Martin grade. The weak angiographic spot was completely obliterated in all patients with acute embolization, with varying degrees of nidus resolution; nevertheless, some patients had a spontaneous recurrence of their bAVM, while others had spontaneous resolution over time. There were no new angiographic weak spots in any of the patients.
In the early stages of recovery from burst bAVMs, acutely targeted embolization of weak angiographic spots, particularly aneurysms, is theoretically safe and protective. Following focused and definitive therapies, serial follow-up imaging is required to track the nidus’ progression. Larger prospective investigations are necessary to confirm these findings.
Reference:thejns.org/view/journals/j-neurosurg/135/6/article-p1598.xml
