Document Detail


Adjuvant embolization with N-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations: outcomes, complications, and predictors of neurologic deficits.
MedLine Citation:
PMID:  19478232     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 < or =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.
Authors:
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
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-05-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-28     Completed Date:  2009-08-19     Revised Date:  2010-09-24    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2783-90     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Columbia University, 710 West 168th Street, Room 428, Neurological Institute, New York, NY 10032, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Chemotherapy, Adjuvant
Child
Child, Preschool
Embolization, Therapeutic / methods*
Enbucrilate / administration & dosage*
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / drug therapy*,  surgery
Male
Middle Aged
Nervous System Diseases / etiology*,  prevention & control
Postoperative Complications / etiology*,  prevention & control
Predictive Value of Tests
Retrospective Studies
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
R01 NS040409-07/NS/NINDS NIH HHS; UL1RR025750/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
6606-65-1/Enbucrilate
Comments/Corrections

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