Embolization as stand-alone strategy for pediatric low-grade brain arteriovenous malformations

J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107137. doi: 10.1016/j.jstrokecerebrovasdis.2023.107137. Epub 2023 Apr 15.


Objectives: We evaluated the safety and efficacy of endovascular embolization as first-line stand-alone strategy for the treatment of low-grade brain arteriovenous malformations (bAVMs) (Spetzler Martin [SM] grade I and II) in pediatric patients. In addition, we assessed the predictors of procedure-related complications and radiographic complete obliteration in a single session.

Material and methods: We conducted a single center retrospective cohort study of all pediatric (≤18 years) patients who underwent embolization as a stand-alone strategy for low-grade bAVMs between 2010 and 2022. Safety was measured by procedure-related complications and mortality. Efficacy was defined as complete angiographic obliteration after the last embolization session.

Results: Sixty-eight patients (41 females; median age 14 years) underwent a total of 102 embolization sessions. There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Six procedure-related complications (5.8% of procedures) were observed and no deaths were reported. All the complications were intraoperative nidus ruptures. A single draining vein was the only significant predictor of procedure-related complications (OR=0.10; 95% CI 0.01 - 0.72; p=0.048). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (51%) the bAVM was completely occluded in one session. The bAVM nidal size was a predictor of complete obliteration in one session (OR=0.44; 95% CI, 0.21-0.80; p=0.017).

Conclusion: Endovascular treatment as a stand-alone strategy for pediatric low-grade bAVMs is an adequate first-line approach in high volume centers with endovascular expertise. Nidal size evaluation is relevant in order to optimize patient selection for embolization as a stand-alone treatment modality.

Keywords: Arteriovenous malformations; Embolization; Pediatric; Stroke.

MeSH terms

  • Adolescent
  • Angiography
  • Brain
  • Child
  • Embolization, Therapeutic* / adverse effects
  • Embolization, Therapeutic* / methods
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations* / surgery
  • Intracranial Arteriovenous Malformations* / therapy
  • Radiosurgery*
  • Retrospective Studies
  • Treatment Outcome