First Experience in the Control of the Venous Side of the Brain AVM
Background and purpose: Brain arteriovenous malformations (AVM) are increasingly curable with endovascular embolization. This study examines the preliminary experience with a novel double-sided hybrid approach in the treatment of cerebral arteriovenous malformations (AVM) versus a purely single-side...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/24/5771 |
| _version_ | 1797503529533833216 |
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| author | Stephan Waldeck Rene Chapot Christian von Falck Matthias F. Froelich Marc Brockmann Daniel Overhoff |
| author_facet | Stephan Waldeck Rene Chapot Christian von Falck Matthias F. Froelich Marc Brockmann Daniel Overhoff |
| author_sort | Stephan Waldeck |
| collection | DOAJ |
| description | Background and purpose: Brain arteriovenous malformations (AVM) are increasingly curable with endovascular embolization. This study examines the preliminary experience with a novel double-sided hybrid approach in the treatment of cerebral arteriovenous malformations (AVM) versus a purely single-sided intra-arterial approach. Materials and methods: The single-center study cohort included 18 patients with brain AVMs (Spetzler–Martin Grade 2 or 3) having stand-alone endovascular treatment with either the arterial-side-only pressure cooker technique (aPCT) (group 1; <i>n</i> = 9) or a double-sided hybrid intra-arterial and transvenous approach (HIPRENE) (group 2; <i>n</i> = 9). Results: Patients belonging to group 2 had lower rates of intra-procedural hemorrhaging (66.7% vs. 33.3%, <i>p</i> = 0.169) and needed fewer treatment sessions to achieve nidus occlusion (1.7 vs. 1.2, <i>p</i> = 0.136). The HIPRENE treatment regime led to higher nidus occlusion rates after the initial treatment compared to aPCT (77.7% vs. 44.4%, <i>p</i> = 0.167). Group 2 patients had a lower rate of neuromonitoring events (22.2% vs. 44.4%, <i>p</i> = 0.310) and fewer accounts of blood flow obstruction in post-operative MRIs (33.3% vs. 55.6%, <i>p</i> = 0.319). Conclusion: A double-sided hybrid intra-arterial and transvenous approach might have benefits for curative endovascular brain AVM treatment in patients with Spetzler–Martin Grade 2 or 3. In our small study cohort, the HIPRENE treatment regime had higher nidus occlusion rates after the first treatment, which reduces the number of treatment sessions and lowers intra- and post-operative complication rates. Further randomized controlled studies are awaited to corroborate our preliminary outcomes. |
| first_indexed | 2024-03-10T03:51:57Z |
| format | Article |
| id | doaj.art-b9cd6a6ac46f4ff09f4ba512badf81a2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T03:51:57Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b9cd6a6ac46f4ff09f4ba512badf81a22023-11-23T08:55:59ZengMDPI AGJournal of Clinical Medicine2077-03832021-12-011024577110.3390/jcm10245771First Experience in the Control of the Venous Side of the Brain AVMStephan Waldeck0Rene Chapot1Christian von Falck2Matthias F. Froelich3Marc Brockmann4Daniel Overhoff5Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, GermanyDepartment of Neuroradiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Strasse 21, 45131 Essen, GermanyInstitute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, GermanyDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, GermanyInstitute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, GermanyDepartment of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, GermanyBackground and purpose: Brain arteriovenous malformations (AVM) are increasingly curable with endovascular embolization. This study examines the preliminary experience with a novel double-sided hybrid approach in the treatment of cerebral arteriovenous malformations (AVM) versus a purely single-sided intra-arterial approach. Materials and methods: The single-center study cohort included 18 patients with brain AVMs (Spetzler–Martin Grade 2 or 3) having stand-alone endovascular treatment with either the arterial-side-only pressure cooker technique (aPCT) (group 1; <i>n</i> = 9) or a double-sided hybrid intra-arterial and transvenous approach (HIPRENE) (group 2; <i>n</i> = 9). Results: Patients belonging to group 2 had lower rates of intra-procedural hemorrhaging (66.7% vs. 33.3%, <i>p</i> = 0.169) and needed fewer treatment sessions to achieve nidus occlusion (1.7 vs. 1.2, <i>p</i> = 0.136). The HIPRENE treatment regime led to higher nidus occlusion rates after the initial treatment compared to aPCT (77.7% vs. 44.4%, <i>p</i> = 0.167). Group 2 patients had a lower rate of neuromonitoring events (22.2% vs. 44.4%, <i>p</i> = 0.310) and fewer accounts of blood flow obstruction in post-operative MRIs (33.3% vs. 55.6%, <i>p</i> = 0.319). Conclusion: A double-sided hybrid intra-arterial and transvenous approach might have benefits for curative endovascular brain AVM treatment in patients with Spetzler–Martin Grade 2 or 3. In our small study cohort, the HIPRENE treatment regime had higher nidus occlusion rates after the first treatment, which reduces the number of treatment sessions and lowers intra- and post-operative complication rates. Further randomized controlled studies are awaited to corroborate our preliminary outcomes.https://www.mdpi.com/2077-0383/10/24/5771cerebral arteriovenous malformationpressure cooker techniquetransvenous approach |
| spellingShingle | Stephan Waldeck Rene Chapot Christian von Falck Matthias F. Froelich Marc Brockmann Daniel Overhoff First Experience in the Control of the Venous Side of the Brain AVM Journal of Clinical Medicine cerebral arteriovenous malformation pressure cooker technique transvenous approach |
| title | First Experience in the Control of the Venous Side of the Brain AVM |
| title_full | First Experience in the Control of the Venous Side of the Brain AVM |
| title_fullStr | First Experience in the Control of the Venous Side of the Brain AVM |
| title_full_unstemmed | First Experience in the Control of the Venous Side of the Brain AVM |
| title_short | First Experience in the Control of the Venous Side of the Brain AVM |
| title_sort | first experience in the control of the venous side of the brain avm |
| topic | cerebral arteriovenous malformation pressure cooker technique transvenous approach |
| url | https://www.mdpi.com/2077-0383/10/24/5771 |
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