BACKGROUND An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms. Endovascular treatment of these flow-related aneurysms can offer a cure, while avoiding open surgery. Successful flow-diverting embolization techniques, efficacy, and outcomes have been previously described for a variety of aneurysm types and locations. However, use of a flow diverter has not been previously described for the treatment of high-flow aneurysms on AVM-feeding vessels. CASE PRESENTATION We report 2 cases of large AVMs within eloquent cortex associated with flow-related aneurysms in patients presenting initially with suspected intracerebral hemorrhage secondary to AVM rupture. DISCUSSION No consensus currently exists to guide treatment of intracranial aneurysms associated with AVMs. Surgical management addressed AVM embolization initially, as the vasculopathology with the highest rupture risk. Subsequently, Pipeline embolization of the associated aneurysms with adequate antiplatelet treatment was performed before scheduled radiosurgery to decrease the risk of AVM rupture or rebleed. This represents a novel and promising use of the Pipeline Embolization Device. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

中文翻译：

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与动静脉畸形相关的血流相关动脉瘤的管道弹性栓塞：病例报告。

背景 估计有 0.1% 的人口患有脑动静脉畸形 (AVM)。AVM 的诊断和检查包括对 AVM 血管结构特征的全面评估和对伴随动脉瘤的仔细评估。共存动脉瘤的存在与颅内出血风险增加有关，与单独 AVM 患者的风险为 3% 相比，每年公布的风险为 7%。全面的 AVM 管理需要识别合并的动脉瘤，并优先考虑治疗策略，以减轻合并有动脉瘤的患者与 AVM 破裂相关的颅内出血的总体风险。这些与血流相关的动脉瘤的血管内治疗可以治愈，同时避免开腹手术。成功的分流栓塞技术、疗效、先前已经描述了各种动脉瘤类型和位置的结果。然而，以前没有描述过使用分流器来治疗 AVM 供血血管上的高流量动脉瘤。病例介绍 我们报告了 2 例与血流相关的动脉瘤相关的功能性皮质内的大型 AVM，这些患者最初出现疑似 AVM 破裂继发的脑内出血。讨论 目前尚无共识来指导与 AVM 相关的颅内动脉瘤的治疗。手术治疗最初将 AVM 栓塞作为破裂风险最高的血管病理学。随后，在预定的放射外科手术之前，对相关动脉瘤进行了充分抗血小板治疗的管道栓塞，以降低 AVM 破裂或再出血的风险。这代表了管道栓塞装置的一种新颖且有前途的用途。需要更多病例和更长的随访时间来进一步评估该技术的有效性。