Arteriovenous malformations embolization in the modern era: case series report

Abstract

Background: Cerebral arteriovenous malformations are complex high-flow lesions that can result in devastating neurological injury when they hemorrhage. Embolization for cerebral arteriovenous malformations has evolved in the last decade with evolution in both equipment and material. Endovascular interventions within arteriovenous malformations may include curative exclusion of arteriovenous malformations from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Fortunately, care by a multidisciplinary team experienced in the comprehensive management of arteriovenous malformations can offer excellent results in most cases. Material and methods: We report the technical and management outcomes of our first cases of cerebral arteriovenous malformations treated with embolization. The clinical, angiographic, treatment, and outcome variables of consecutive cerebral arteriovenous malformation cases, treated with curative embolization between September 2019 and April 2021 in our center were retrospectively analyzed. Results: In 12 patients, 12 arteriovenous malformations were identified. Fourteen embolization sessions were done. No cases of early hemorrhage after embolization occurred. All the patients were discharged at grade below 2 mRS. Angiographic cure was achieved in 2 patients (17%). The average size reduction was 80 %. Conclusions: Embolization is a critical component of the multimodality treatment of cerebral arteriovenous malformations. It is clear that many arteriovenous malformations cannot be safely cured without the judicious use of this modality. In addition, embolization could serve as a curative option for arteriovenous malformations treatment with accepted morbidity and mortality.