Therapeutic Effect Of Endovascular Embolization On Brain Arteriovenous Malformation With Aneurysm

Objective:To explore the influencing factors of embolization for the treatment of brain arteriovenous malformation(BAVM)with aneurysm,and to develop a treatment strategy.Methods:To retrospective analysis of 49 patients with BAVM combined with aneurysm in our hospital,47 patients with a single aneurysm were classified by the classification of Redekop,and the risk of intracranial hemorrhage in different types of patients was analyzed.Multiple linear regression analysis was used to analyze the influencing factors of the Glasgow Outcome Scale(GOS)and construct a regression model.After 3 months,all patients underwent the angiography,and observed whether the lesion had recurrence.Results:The patients of BAVM with aneurysms have a higher risk of intracranial hemorrhage,especially in patients with distal and intranidal aneurysms.Multivariate analysis found that the gender,the age,the classification of Redekop,the maximum diameter of aneurysm,and the location of BAVM were not significantly correlated with the GOS,while the Glasgow Coma Scale(GCS),the grade of Spetzler-Martin(SM),the morphology of aneurysm,and the embolization volume of BAVM were significantly correlated with the GOS.Multiple linear regression analysis showed that the GCS and the embolization volume of BAVM was positively correlated with the GOS,while the grade of SM and the morphology of aneurysm was negatively correlated with the GOS.There were 2 patients with multiple aneurysms.There were two flow-related aneurysms in patients with multiple aneurysms were untreated,while the remaining aneurysms were embolized.BAVM lesions were embolized to different degrees.Among all patients,1 patient had visual impairment,2 patients had physical activity disorder,and 1 patient died.48 patients had no recurrence with angiography after 3 months.Conclusion:The patients of BAVM with aneurysm have a high risk of hemorrhage.That patients with intranidal and distal arterial aneurysms were more likely to cause hemorrhage,while the classification of Redekop have no significantly impact on the GOS.Therefore,this patients should be treated as soon as possible.That patients with higher GCS,lower SM grades,and more regular aneurysm have better outcomes,Therefore,that can active embolization for treatment.The postoperative outcomes of patient can be pre-evaluated by the regression model,so that we can develop appropriate treatment strategies.It can reduce complications such as postoperative hemorrhage and improve the safety and effectiveness of interventional therapy.Treatment of BAVM with aneurysms should be preceded by treatment of the associated aneurysm to reduce the risk of postoperative pressure increase leading to rupture of the associated aneurysm,and the curative embolization of BAVM can improve efficacy and reduce recurrence.