1081. Embolization for Cure in the Treatment of Brain Arteriovenous Malformations: A Systematic Review
Authors: Tarek Y. El Ahmadieh, MD; Eva Wu, BS; Cameron McDougall, MD; Salah Aoun, MD; Om Neeley, MD; Aaron Plitt, MD; Vin Shen Ban; Rafael Sillero, MD; Jonathan White, MD; Hunt Batjer, MD; Babu Welch, MD (Dallas, TX)
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. We reviewed the literature to assess the lesional characteristics, technical factors, angiographic and clinical outcomes of endovascular embolization of AVMs with intent-to-cure.
Electronic databases (OvidMedline, OvidEmbase and Pubmed) were searched. The primary outcomes of interest were angiographic obliteration immediately post-embolization and at follow-up. The secondary outcomes of interest were complication rates. Descriptive statistics were used to calculate rates and means.
Fifteen studies with 597 patients and 598 AVMs treated with an intent-to-cure embolization were included. Thirty-four percent of AVMs were Spetzler-Martin grade III. Complete obliteration immediately post-embolization was reported in 58.3% of AVMs that completed treatment and in 45.8% of AVMs in the entire cohort of patients. The overall clinical complication rate was 24.1%. The most common complication was hemorrhage 9.7%. Procedure related mortality was 1.5%.
While endovascular embolization with intent-to-cure can be an option in select AVMs, the reported complication rates appear to be increased over selected studies where adjunctive embolization was the goal. Given the high complication rate related to primary embolization approach, the risks and benefits of such treatment strategy should be discussed among multidisciplinary teams. Curative embolization in AVMs should be considered an unanticipated benefit of such therapy rather than a goal.