Endovascular treatment as the first-line approach for cure of low-grade brain arteriovenous malformation

Abstract

OBJECTIVE While microsurgery has been proposed as the first-line treatment for patients with low-grade (Spetzler-Martin grade I or II) brain arteriovenous malformations (bAVMs), recent studies have shown promising results for endovascular treatment (EVT) as a single proper choice for the management of this group of bAVMs. In this study, the authors evaluated the safety and efficacy of EVT as a first-line strategy for curing low-grade bAVMs at their center. METHODS All patients with low-grade bAVMs managed primarily by EVT between 2015 and 2021 were enrolled in this study. Patients were evaluated and treated by the same team and followed with the same protocol. The primary endpoint was the efficacy of EVT on the cure of low-grade bAVMs. The second endpoint was the safety of EVT for the treatment of low-grade bAVMs, including procedural complications and long-term clinical outcomes. RESULTS A total of 109 patients were enrolled and represented in the study population. The mean patient age was 31.6 ± 14.8 years. Forty-eight AVMs (44%) were Spetzler-Martin grade I and 61 (56%) were grade II. Of 99 patients who completed their EVT sessions, complete exclusion was achieved in 89 patients (89.9%). Overall, complete exclusion was achieved in 59.6% of patients after a single EVT session. At the 6-month follow-up, 106 patients (97.2%) had a favorable outcome. Four patients (4.6%) experienced transient neurological deficits, and 1 patient (0.9%) had a permanent neurological deficit. CONCLUSIONS EVT can be offered as the first choice of treatment for select patients with low-grade bAVMs, with a high cure rate and low morbidity.

Endovascular embolization of Spetzler-Martin Grade I brain arteriovenous malformations: A case report on patient-centered neurointervention

“…The indication for endovascular therapy in AVM management, particularly for low-grade (SM I–II) AVM, has gained traction as a primary therapeutic option or as an adjunct to microsurgery and radiosurgery. This shift is supported by the literature, which acknowledges the high cure rates and relatively low complication rates associated with microsurgical resection, while also recognizing the potential of endovascular treatment to offer a less invasive yet effective alternative for nidus obliteration [ 4 , 7 ]. Studies by Ikedo et al (2023) and Lawton & Lang (2019) further illustrate the tailored approach to multimodal treatment, suggesting that personalized strategies, incorporating endovascular intervention, are both safe and effective for managing unruptured AVM [ 8 , 9 ].…”

Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

“…Palliative embolization was proposed to improve neurologic deficits or seizures by relieving venous drainage hypertension 1 . Curative embolization tends to be appropriate for low-grade AVMs (SM grade 1–3) with simple angioarchitecture 7 , 27 , 28 . However, there is currently insufficient data to support the safety and efficacy of these embolization strategies.…”

“…The complete occlusion rate of stand-alone AVM embolization has been reported to be 23.5–95% 7 , 9 , 10 , especially in low-grade AVMs (SM grade 1–3) with simple vascular structures (89.9–95%) 7 , 27 , 28 . In the present study, the complete obliteration rate of unruptured AVMs was 23.6%, and 45.3% in ruptured AVMs where curative embolization was planned, which was consistent with the previous series.…”

Endovascular Treatment of Brain Arteriovenous Malformations in Pediatric Patients: A Single Center Experience and Review of the Literature

“…However, this is also true for endovascular treatment. 19 A few large sample studies [19][20][21] have demonstrated both high effectiveness and safety in Spetzler-Ponce class A bAVMs (Spetzler-Martin grades I and II) managed by endovascular treatment, which may constitute a suitable alternative to surgical excision in selected cases. In our series, all five patients with bAVM angiographic obliteration after endovascular embolization were classified as Spetzler-Ponce class A (Spetzler-Martin grades I-II).…”