SQUID embolization for cerebral AVMs: 1-year safety and efficacy results from the CHOICE prospective multicenter...

Most patients with brain arteriovenous malformations (bAVMs) present with or eventually develop symptoms, while facing a persistent risk of rupture. Management remains challenging, and treatment practices continue to evolve. In this study, the safety and efficacy of embolization with the SQUID (BALT Group, Gland,Switzerland) embolic agent, used either as a standalone therapy or in combination with other modalities, were assessed.

CHOICE is a prospective, observational, multicenter study conducted at 21 mainly European centers. Adults with previously untreated bAVMs were treated with SQUID, either as embolization alone or before neurosurgery or radiosurgery. The primary endpoint was SQUID- or procedure-related morbidity-mortality, at 3-6 months after last embolization or before further therapy. Secondary endpoints included bAVM occlusion at 3-6 months post-last embolization and safety at 12 months.

Among the 109 patients included (46.3±15 years, 50.5% male), 80.7% underwent embolization alone and 19.3% had further therapy. Most bAVMs were Spetzler-Martin grade I-II (67%) and <3 cm in diameter (78.9%). Morbidity-mortality related to SQUID and/or procedure at 3-6 months were 11% and 0% respectively, including 6.4% SQUID-related morbidity. At 12 months, these rates were 7.8% and 0% respectively, including 4.9% of SQUID-related morbidity. Complete bAVM occlusion at 3-6 months post-last embolization was achieved in 63.2% in embolization alone patients and 19.0% in patients with embolization before further therapy. The overall complete occlusion rate was 53.6%.

CHOICE study results suggest good safety and efficacy of SQUID as a standalone treatment or in association with surgical treatment.

NCT03413852.