Neurointervention · IR Playbook

Endovascular Embolization of Brain Arteriovenous (AVM)

Superselective transarterial (occasionally transvenous) delivery of a liquid embolic agent into the nidus of a brain arteriovenous malformation, performed as curative, presurgical, preradiosurgical or targeted palliative therapy. The nidus is a low-resistance arteriovenous shunt without intervening capillary bed, so embolic must fill the nidal compartment itself and the proximal draining vein only after the nidus is filled; occluding feeders proximally or the vein prematurely does not reduce haemorrhage risk and may precipitate rupture. Complete obliteration by embolization alone is achieved in roughly 40 to 55 percent of selected cases in modern detachable-tip and pressure-cooker series, with clinical complications in approximately 9 to 20 percent of sessions and periprocedural haemorrhage in about 3 to 5 percent per procedure. Guideline-supported: for unruptured AVMs the ARUBA trial showed medical management superior to intervention over 33 months and at extended follow-up, so unruptured cases require multidisciplinary justification.

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