Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment.
To evaluate the results of endovascular treatment of patients having both arteriovenous malformations and aneurysms. Two hundred seventy consecutive patients underwent pretherapeutic selective and superselective angiography. In each patient, the following were recorded: demographic information; clinical symptoms; location of the arteriovenous malformation, including presence of aneurysms; therapeutic interventions and immediate anatomic results; and clinical and angiographic follow-up data. Every patient who had at least one angiographically confirmed arterial aneurysm at presentation was included in the study. Arterial aneurysms were found in 30 (11%) of 270 patients in the population with arteriovenous malformations. Fifteen (50%) of 30 patients with aneurysms had a hemorrhage at presentation. Only 66 (27.5%) of 240 patients without aneurysms had a hemorrhage at presentation. The coexistence of arteriovenous malformations and aneurysms correlated significantly with intracranial hemorrhage at presentation (P <.05). When an aneurysm was believed to be responsible for a hemorrhage and whenever possible, it was treated before the arteriovenous malformation was treated. Treatments were protective against hemorrhage or recurrence of hemorrhage in all cases. Five of 30 patients had neurologic deficits as a result of endovascular treatment of both aneurysms and arteriovenous malformations. Findings in this study highlight the importance of recognizing aneurysms in patients with arteriovenous malformations. A strategic focus on the circulatory exclusion of associated aneurysms, especially when such lesions have been responsible for a hemorrhagic episode, is recommended.