Embolization of brain arteriovenous malformations with intent to cure: a systematic review
Search for other papers by Eva M. Wu in
Current site
Google Scholar
PubMed
Search for other papers by Tarek Y. El Ahmadieh in
Current site
Google Scholar
PubMed
Search for other papers by Cameron M. McDougall in
Current site
Google Scholar
PubMed
Search for other papers by Salah G. Aoun in
Current site
Google Scholar
PubMed
Search for other papers by Nikhil Mehta in
Current site
Google Scholar
PubMed
Search for other papers by Om James Neeley in
Current site
Google Scholar
PubMed
Search for other papers by Aaron Plitt in
Current site
Google Scholar
PubMed
Search for other papers by Vin Shen Ban in
Current site
Google Scholar
PubMed
Search for other papers by Rafael Sillero in
Current site
Google Scholar
PubMed
Search for other papers by Jonathan A. White in
Current site
Google Scholar
PubMed
Search for other papers by H. Hunt Batjer in
Current site
Google Scholar
PubMed
Search for other papers by Babu G. Welch in
Current site
Google Scholar
PubMed
OBJECTIVE
Endovascular embolization has been established as an adjuvant treatment strategy for brain arteriovenous malformations (AVMs). A growing body of literature has discussed curative embolization for select lesions. The transition of endovascular embolization from an adjunctive to a definitive treatment modality remains controversial. Here, the authors reviewed the literature to assess the lesional characteristics, technical factors, and angiographic and clinical outcomes of endovascular embolization of AVMs with intent to cure.
METHODS
Electronic databases—Ovid MEDLINE, Ovid Embase, and PubMed—were searched for studies in which there was evidence of AVMs treated using endovascular embolization with intent to cure. The primary outcomes of interest were angiographic obliteration immediately postembolization and at follow-up. The secondary outcomes of interest were complication rates. Descriptive statistics were used to calculate rates and means.
RESULTS
Fifteen studies with 597 patients and 598 AVMs treated with intent-to-cure embolization were included in this analysis. Thirty-four percent of AVMs were Spetzler-Martin grade III. Complete obliteration immediately postembolization was reported in 58.3% of AVMs that had complete treatment and in 45.8% of AVMs in the entire patient cohort. The overall clinical complication rate was 24.1%. The most common complication was hemorrhage, occurring in 9.7% of patients. Procedure-related mortality was 1.5%.
CONCLUSIONS
While endovascular embolization with intent to cure can be an option for select AVMs, the reported complication rates appear to be increased compared with those in studies in which adjunctive embolization was the goal. Given the high complication rate related to a primary embolization approach, the risks and benefits of such a treatment strategy should be discussed among a multidisciplinary team. Curative embolization of AVMs should be considered an unanticipated benefit of such therapy rather than a goal.
ABBREVIATIONS
AVM = arteriovenous malformation; DACT = double arterial catheterization; DSA = digital subtraction angiography; EVD = external ventricular device; MRA = MR angiography; NBCA = N-butyl cyanoacrylate; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Image from Ryu et al. (pp 442–455).
© Copyright 1944-2023 American Association of Neurological Surgeons