Association of cerebral arteriovenous malformations and spontaneous occlusion of major feeding arteries: Clinical and therapeutic implications

OBJECTIVE: The spontaneous occlusion of a cerebral arteriovenous malformati on (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is eve n more rare, and its incidence is unknown. We undertook this study to deter mine the incidence of occlusion of a major artery feeding an AVM and to rec ommend a management strategy for such an AVM. METHODS: We identified AVMs associated with an occluded artery by performin g a retrospective angiographic analysis of 500 patients with AVMs who prese nted to Henry Ford Hospital from 1976 to 1998. RESULTS: A review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occlu ded; in two patients, the M1 segment of the middle cerebral artery was occl uded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with t he exception of one who had vertebral artery occlusion. Five patients under went definitive treatment: one received radiosurgery, and four underwent su rgical excision. One of the surgically treated patients died of complicatio ns from excessive blood loss and coagulopathy, but the other three had no p ostoperative complications. CONCLUSION: The occlusion of a major artery feeding an AVM occurs rarely (1 .4%). These AVMs are moderate to large in size (>3 cm). To prevent collater al flow-related complications of cortical "steal" and hemorrhage, as well a s the usual risk of hemorrhage from the AVM itself, surgical management sho uld be considered for these AVMs.