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Partial transvenous embolization as an intermediate strategy for large brain arteriovenous malformations: A technical

Ryuichi Noda1,2, Vinicius Moreira Lima3, Christina Iosif4

  • 1Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France rnrn46_8447@yahoo.co.jp.

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Partial transvenous embolization (pTVE) is a new technique for treating large brain arteriovenous malformations (bAVMs). This intermediate embolization session reduces complications in patients with complex venous drainage.

Keywords:
Arteriovenous MalformationBrainHemorrhage

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Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Endovascular transvenous embolization (TVE) is a curative treatment for brain arteriovenous malformations (bAVMs) with small nidi and single draining veins.
  • Larger bAVMs with multiple venous outlets pose treatment challenges.
  • Partial transvenous embolization (pTVE) is introduced as an intermediate embolization strategy.

Purpose of the Study:

  • To describe a novel partial transvenous embolization (pTVE) technique.
  • To evaluate pTVE as an adjunct for treating large brain arteriovenous malformations (bAVMs).
  • To assess the safety and efficacy of pTVE in reducing hemorrhagic complications.

Main Methods:

  • A retrospective review of a single-center database of bAVMs treated endovascularly from January 2023 to March 2024.
  • Six consecutive patients with ruptured bAVMs underwent 10 sessions of pTVE.
  • Detailed analysis of venous angioarchitecture and technical particularities.

Main Results:

  • The median patient age was 24.5 years, with median nidus size of 5 cm.
  • Patients presented with Spetzler-Martin grades III (n=3), IV (n=2), and V (n=1).
  • pTVE achieved partial occlusion in all cases without hemorrhagic complications; one patient achieved total occlusion after two sessions.

Conclusions:

  • Partial transvenous embolization (pTVE) is a novel technique for managing large bAVMs.
  • pTVE serves as an effective adjunct strategy to reduce complications.
  • Subcategorization of venous angioarchitecture aids in treatment decision-making.