Endovasküler yolla tedavi edilen intrakraniyal arteriyovenöz malformasyon ile takipli olgularda ethylene-vinyl alcohol copolymer (ONYX ®) ve bırakılabilir mikrokateter yapılan tedavilerin başarı ve komplikasyon oranlarının değerlendirilmesi
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Date
2017
Authors
Özpar, Rifat
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
İntrakraniyal arteriyovenöz malformasyonlar (AVM); intrakraniyal hemorajilerin etyolojisinde yer alan ve en sık semptom veren şantlı vasküler malformasyonlardır. Tedavi seçenekleri cerrahi eksizyon, endovasküler embolizasyon ve radyocerrahidir. Bırakılabilir uçlu mikrokateterler ve Ethylene-Vinyl Alcohol Copolymer (Onyx ®) kullanılarak yapılan endovasküler embolizasyon işlemlerinin; total embolizasyon başarısının ve işlem sonrası meydana gelen ölüm ile komplikasyon oranlarının değerlendirilmesi amaçlandı. AVM'si bulunan ve departmanımızda endovasküler yolla bırakılabilir mikrokateter ile Onyx ® kullanılarak tedavi edilen 43 olgu çalışmamıza dahil edildi. Her bir olgunun embolizasyon öncesi dönemdeki klinik ve radyolojik bulguları, embolizasyon seansına ait verileri ve seans sonrası takip dönemine ait klinik ve radyolojik bulgular tespit edildi. 43 olgu için toplam 51 tedavi seansı yapıldı. Yapılan tedavi seanslarında total embolizasyon oranı %33,3, ölüm oranı %4,7, komplikasyon oranı %24,4 olarak izlendi. Rüptüre olmamış AVM nedeniyle tedavi edilen ve işlem sonrası komplikasyon gelişen olgularda, komplikasyonlarla ilişkili majör nörolojik defisit görülmedi. Komplikasyon gelişenlerin hepsinde embolizasyon düzeyi parsiyeldi. AVM çapı ile embolizasyon düzeyi ve komplikasyon gelişimi arasında, Spetzler-Martin derecesi ile ölüm arasında anlamlı ilişki saptandı. Yapılan tedavilerde kateter retansiyonu ve iatrojenik rüptür gözlenmedi. AVM'lerde bırakılabilir mikrokateter ve Onyx ® ile yapılan endovasküler embolizasyon işlemi; küratif etkinliği bulunan, total embolizasyon sağlandığı takdirde düşük mortalite ve morbidite riski taşıyan bir tedavi yöntemidir.
Intracranial arteriovenous malformations (AVM) are shunting vascular malformations and they are in the etiology of intracranial hemorrhages. Accepted treatment options are surgical excision, endovascular embolization and radiosurgery. The aim of this study was to evaluate the success, death and complication rates of endovascular embolization procedures using detachable-tip microcatheter and Ethylene-Vinyl Alcohol Copolymer (Onyx ®). 43 patients having AVMs treated by endovascular embolization with detachable-tip microcatheter and Onyx ® were retrieved from database. Data of each embolization procedure, clinical and radiological findings of each patient before embolization and after embolization procedure were evaluated. Frequencies and associations of these findings were investigated. 51 embolization sessions were made in a total of 43 patients. In the procedures; total succesful embolization rate was about 33,3%, mortality rate was 4,7% and complication rate was around 24,4%. Major neurologic deficits didn't develop in patients treated for unruptured AVMs and having some complications related to the procedure. All patients having complications related to procedure were partially embolizated. There were significant relationships between the size of the malformation, level of embolization and complication rates. Additonally; Spetzler-Martin grade and mortality rate were significantly related to each other. Microcatheter complications such as microcatheter retention or iatrogenic hemorrhage were not seen in any patients. According to the our study, endovascular embolization procedures using detachable-tip microcatheters and Onyx ® is found to be curative treatment method and if total embolization may be achieved with this technique, mortality and morbidity rates will remain low.
Intracranial arteriovenous malformations (AVM) are shunting vascular malformations and they are in the etiology of intracranial hemorrhages. Accepted treatment options are surgical excision, endovascular embolization and radiosurgery. The aim of this study was to evaluate the success, death and complication rates of endovascular embolization procedures using detachable-tip microcatheter and Ethylene-Vinyl Alcohol Copolymer (Onyx ®). 43 patients having AVMs treated by endovascular embolization with detachable-tip microcatheter and Onyx ® were retrieved from database. Data of each embolization procedure, clinical and radiological findings of each patient before embolization and after embolization procedure were evaluated. Frequencies and associations of these findings were investigated. 51 embolization sessions were made in a total of 43 patients. In the procedures; total succesful embolization rate was about 33,3%, mortality rate was 4,7% and complication rate was around 24,4%. Major neurologic deficits didn't develop in patients treated for unruptured AVMs and having some complications related to the procedure. All patients having complications related to procedure were partially embolizated. There were significant relationships between the size of the malformation, level of embolization and complication rates. Additonally; Spetzler-Martin grade and mortality rate were significantly related to each other. Microcatheter complications such as microcatheter retention or iatrogenic hemorrhage were not seen in any patients. According to the our study, endovascular embolization procedures using detachable-tip microcatheters and Onyx ® is found to be curative treatment method and if total embolization may be achieved with this technique, mortality and morbidity rates will remain low.
Description
Keywords
Arteriyovenöz malformasyon, Onyx, Bırakılabilir mikrokateter, Embolizasyon, Arteriovenous malformation, Detachable microcatheter, Embolization
Citation
Özpar, R. (2017). Endovasküler yolla tedavi edilen intrakraniyal arteriyovenöz malformasyon ile takipli olgularda ethylene-vinyl alcohol copolymer (ONYX ®) ve bırakılabilir mikrokateter yapılan tedavilerin başarı ve komplikasyon oranlarının değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.