Specific Complications of HHT: Brain AVM

10-15% of patients with HHT have at least one brain AVM, and, without treatment, brain AVM are a common cause of hemorrhagic stroke in HHT families.

General Information & Prevention

• If you have high blood pressure, this should be kept under control.
• Avoid sudden straining movements like lifting heavy boxes or heavy weight lifting.
• Avoid blood thinners or nonsteroidal antiinflammatory medicines like aspirin and ibuprofen as they can worsen bleeding tendencies. Tylenol®, Bextra®, Celebrex®, and Vioxx® are generally okay.
• Report any of the following symptoms to your doctor as soon as possible:
  • sudden weakness in your arms or legs
  • difficulty talking
  • blacking out spells
  • severe headaches.

Treatment

Embolization: This involves blocking off the artery that leads into or “feeds” the AVM with a tiny balloon or with glue.  In either case, this stops the blood flow into the AVM and lessens the risk of stroke. This is accomplished by passing a small catheter through an artery in the leg and then passing it up to the arteries of the brain. The procedure is successful in initially blocking off the AVM more than 95% of the time and has a relatively low complication rate. Some doctors believe that embolization by itself can be curative, while other doctors believe that it should be followed by curative surgery or radiation when possible.

Surgical Removal: This involves a formal surgical procedure to place a clip on the AVM or actually remove the AVM. This procedure is fully curative, but has a higher complication rate than embolization.

Gamma Knife: This is a type of focused radiation that destroys the AVM tissue. This is often done after embolization to ensure that the AVM is cured.