Introduction The role of endovascular embolization in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. Embolization may be performed as a stand‐alone curative treatment or as an adjunct to microsurgical resection or stereotactic radiosurgery. Methods We conducted a single‐center retrospective cohort study of all patients who underwent stand‐alone curative embolization for AVMs at a high‐volume center between 2014 and 2024. Data collected included demographic characteristics, clinical presentation, angioarchitectural features, procedure‐related complications, and angiographic outcomes. Results During the study period, 268 patients (153 females; mean age 29.8 ± 15.2 years) underwent a total of 460 embolization sessions. The mean number of embolizations per patient was 1.7 (range, 1‐8). The most common clinical presentation was headache (66%). Ruptured AVMs accounted for 71.2% of cases, with a mean nidus size of 26.9 ± 13.6 mm. The Spetzler‐Martin grade distribution was grade I in 32 patients (13%), grade II in 96 (41%), grade III in 83 (35%), grade IV in 21 (9%), and grade V in 2 (0.9%). Fifty‐seven patients (24%) had a single feeding artery, and 178 (75.7%) had multiple feeding arteries. Embolization agents used were Squid in 263 sessions (61.7%), Phil in 82 (19.2%), NBCA in 50 (11.7%), and Onyx in 15 (3.5%). The mean volume of embolic agents was 3.4 ml (range, 0.2‐24.9 ml). The mean number of embolized pedicles was of 1.4 (range, 1‐5). The mean follow‐up period was 9.1 ± 16.7 months (range, 1‐96 months). Complete angiographic occlusion was achieved in 182 patients (68%), with 122 patients (46%) achieving complete occlusion in a single session. There were 47 intraprocedural complications, of which 34 (7%) were hemorrhagic, 9 (1.9%) were ischemic, and 6 (1.3%) were due to microcatheter fracture. The temporal trend in angiographic outcomes per session over the study period is shown in the Figure . Conclusion Curative endovascular embolization for brain AVMs appears to be a safe and effective treatment option, achieving complete nidus occlusion with low complication rates when performed in high‐volume centers with specialized endovascular expertise. image
Rodríguez-Calienes et al. (Sat,) studied this question.