[Arteriovenous Malformations:Endovascular Techniques and Devices].

Area of Science:

• Neurology
• Interventional Radiology
• Neurosurgery

Context:

• Cerebral arteriovenous malformations (AVMs) present complex treatment challenges.
• Endovascular embolization using liquid agents is a primary therapeutic modality.
• Onyx and n-butyl cyanoacrylate are key liquid embolic agents available in Japan.

Purpose:

• To compare the efficacy of transarterial embolization (TAE) and transvenous embolization (TVE) for cerebral AVMs.
• To highlight the specific features and appropriate selection criteria for liquid embolic agents.
• To discuss the potential of TVE as a curative option for select AVMs.

Summary:

• Liquid embolization, including agents like Onyx and n-butyl cyanoacrylate, is a safe and effective treatment for cerebral AVMs.
• Transarterial embolization (TAE) is the standard, but transvenous embolization (TVE) is emerging as a potentially curative option for specific AVM subtypes.
• TVE may offer superior AVM obliteration rates in cases with small size, hemorrhagic onset, deep location, inaccessible feeders, or a single draining vein.

Impact:

• Provides insights into optimizing liquid embolization strategies for cerebral AVMs.
• Identifies TVE as a promising alternative or adjunct to TAE in select patient populations.
• Suggests areas for future research, including the role of embolization versus surgery and treatment of unruptured or high-grade AVMs.