Arteriovenous Malformations: Endovascular Indications and Technique

Abstract

Endovascular treatment (EVT) is one of the three main pillars of management of brain arteriovenous malformation (b-AVM). Constant advances in microcatheter technology, embolic agents, and new angiography systems with reduced radiation exposure are likely to continue to expand the role of endovascular therapy in b-AVM treatment. Factors such as natural history, location, size, angioarchitecture, rupture status, and presence of symptoms are considered when determining the role of EVT in the overall patient management. The goal of EVT is defined by these aspects in conjunction with patient medical history and desire of the patient to undergo treatment, as well as local availability of technology and operator experience. Despite the increasing number of case series reporting b-AVM cure after EVT, it is still largely considered a neoadjuvant treatment prior to microsurgery and stereotactic radiosurgery (Liu et al., Interv Neuroradiol 16:47–57, 2010). Nonetheless, it is an important therapeutic option, alongside radiosurgery, for deep-seated lesions.