Abstract
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.