Transvenous Embolization Outperforms Transarterial Approach for Brain AVMs

Introduction Transarterial embolization (TAE) is the most common approach for endovascular treatment of brain AVMs, while transvenous embolization (TVE) plays an increasingly important role as a highly curative technique. However, there is a lack of information on the efficacy and safety of TVE, alone or in combination with TAE. Materials and Methods A systematic review was performed in PubMed, Scopus, Ovid Embase, and Cochrane from inception to March 2025 for all studies that tested the efficacy and safety of transarterial or transvenous embolization of brain AVMs. Efficacy was defined as complete angiographic occlusion, while safety included complications and mortality. We performed a random‐effects Mantel‐Haenszel with DerSimonian & Laird meta‐analysis. Results TVE significantly showed a higher occlusion rate compared to TAE (RR = 1.22 [95% CI, 1.03‐1.45]), p = 0.02; there was moderate between‐study heterogeneity (I 2 = 51.7%, τ 2 = 0.02). For complications, there were no significant differences between TAE and TVE (RR = 0.74 [95% CI, 0.52‐1.06]), p = 0.10; there was no between‐study heterogeneity (I 2 = 0%, τ 2 = 0). Regarding death, there were no significant differences between TAE and TVE (RR = 0.47 [95% CI, 0.12‐1.80]), p = 0.27; there was no between‐study heterogeneity (I 2 = 0%, τ 2 = 0). Conclusion TVE in all its modalities improved complete angiographic occlusion compared to TAE alone, while also showing acceptable complications and mortality rates. Treatment via either approach should be determined on a case‐by‐case basis and according to institutional expertise.