Safety and effectiveness of first-line endovascular management of brain micro- arteriovenous malformations: a single center experience in 34 patients.

PURPOSE: Brain micro-arteriovenous malformations (BMAVMs) treatment is often challenging and considered safe for microsurgical resection. However, the role of endovascular treatment (EVT) remains to be clarified in this indication. The purpose of our study was to assess the safety and effectiveness of endovascular treatment as the first-line therapy for BMAVMs.

METHODS

From our local database, we retrospectively retrieved patients with BMAVMs treated by embolization as first-line therapy in our Department between January 1999 and January 2022. The primary endpoint was the total obliteration rate of BAVMs, and secondary endpoints were hemorrhagic complications, ischemic complications, final outcome assessed through modification of the modified Rankin Scale (mRS) and mortality rate secondary to BMAVM embolization.

RESULTS

Thirty-four patients meeting the inclusion criteria and treated by EVT as first-line therapy were included in the study. Overall, complete exclusion of BMAVMs was achieved in 27/33 patients (81.8%), including 60.6% BMAVMs excluded by EVT alone. Location of the BMAVM (deep or cortical) did not influence the occlusion rate. Early hemorrhagic complications were reported in 8/34 patients (23.5%). No late hemorrhagic complications were reported. Ischemic complications were reported in 6/34 patients (17.6%); procedure-related mortality rate was reported in 1/34 patients (2.9%). An overall good clinical outcome (mRS 0-2) was reported in 24/34 patients (70.6%). Improved /unchanged mRS was reported in 30/34 patients (88.2%).

CONCLUSIONS

Endovascular treatment, alone or associated with other exclusion techniques, has good results in terms of safety and effectiveness. However, despite the small size of the nidus, procedure-related complication risks as well as nidus remnant rates remain significant.