Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents

Article Figures & Data

Table 1:

Summary of embolization-related complications

Complication	Per Session (n = 489) (%)	Per Patient (n = 192) (%)
None	451 (92.2)	158 (82.2)
Non-neurologic	5 (1)	4 (2.1)
Transient neurologic deficit	25 (5.1)	22 (11.5)
Permanent deficit, non-disabling	5 (1.0)	5 (2.6)
Permanent deficit, disabling or death	3 (0.6)	3 (1.6)

Table 2:

Results of univariate analysis looking at any complication (transient or permanent neurologic deficit) during embolization*

Criteria	Odds Ratio (95% CI)	P value
Male Gender	0.80 (0.38–1.69)	.56
Presenting Symptom
Hemorrhage	0.96 (0.42–2.23)	.93
Seizure	0.68 (0.30–1.52)	.35
Headache	0.71 (0.23–2.19)	.55
Neurologic deficit	1.90 (0.76–4.73)	.17
Incidental finding	1.82 (0.46–7.23)	.40
mRS score at diagnosis
0–2	0.90 (0.28–2.88)	.86
3–5	1.11 (0.35–3.52)	.86
AVM Features
Eloquent cortex involved	1.48 (0.57–3.84)	.43
Deep venous drainage	1.07 (0.5–2.3)	.86
Spetzler-Martin grade
I and II	1.50 (0.15–15.46)	.73
III	0.64 (0.07–6.14)	.69
IV	1.09 (0.11–10.35)	.94
V	1.88 (0.19–18.32)	.59
Basal ganglia location	2.11 (0.88–6.10)	.09
Nidal volume reduction (%)
0–24	0.03 (−0.77–0.83)	.96
25–49	−0.19 (−0.63–0.25)	.65
50–74	−0.19 (−0.59–0.21)	.63
>74	0.35 (−0.04–0.74)	.37
Number of embolization sessions
1	0.09 (−0.34–0.52)	.82
2	−0.61 (−1.06–0.16)	.18
3	0.23 (−0.22–0.68)	.61
4+	0.31 (−0.11–0.73)	.46
Number of pedicles embolized
1	−0.33 (−0.68–0.02)	.34
2	0.29 (−0.05–0.63)	.38
3+	0.14 (−0.28–0.56)	.73

Note:—CI indicates confidence interval.
* All data reflect complication rates per patient (n = 192), except for number of pedicles embolized, which reflects rates per session (n = 489).

Table 4:

Treatment-related deficits in recent series of AVM embolization

Series	No. of Patients	No. of Sessions	Permanent Disabling Complication Rate (%)	Notes
Ledezma et al²	168	295	6.5	Described as clinically significant complication, not specifically described as temporary or permanent
Hartmann et al⁴	233	545	3	Rate of permanent nondisabling complications not given
Haw et al⁵	306	513	3.9	Eloquence, presence of fistula or venous glue related to complications
Taylor et al⁸	201	339	11	Includes disabling and nondisabling permanent complications; no risk factors for poor outcome found; series mostly used particulate embolization rather than liquid embolic agents.
Current study	192	489	1.6