Transvenous Embolisation-Based Strategies for Brain Arteriovenous Malformations: Systematic Review and Meta-Analysis

Background: Transvenous embolisation (TVE) has emerged as a promising treatment option for selected brain arteriovenous malformations (bAVMs). Objective: To evaluate the safety and efficacy of TVE-based treatment strategies for bAVMs. Methods: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review and meta-analysis was registered in PROSPERO (CRD420261397818). PubMed, Embase, Cochrane CENTRAL, and Scopus were searched on 20 May 2026, supplemented by citation screening. Studies reporting TVE for bAVMs in ≥5 patients were included. Binary outcomes were pooled using random-effects binomial-normal generalised linear mixed models (GLMMs) with a logit link under an intention-to-treat framework. Results: Twelve studies comprising 239 patients were included; 57.7% underwent combined transarterial/transvenous embolisation. Complete angiographic occlusion was 92.2% (217/239; 95% CI, 84.5-96.2%; I² = 0%) overall and 97.1% (149/160; 95% CI, 76.6-99.7%; I² = 0%) among patients with ≥3 months of imaging follow-up. Functional independence (mRS 0-2) was 85.0% (155/180; 95% CI, 68.7-93.7%; I² = 55%), and technical success was 97.1% (219/227; 95% CI, 91.5-99.0%; I² = 0%). GLMM pooled rates were 0.7% for ischaemic complications, 12.3% for haemorrhagic complications, 3.3% for permanent neurological morbidity, 2.3% for overall mortality, 0.8% for procedure-related mortality, and 13.9% for any procedure-related complication or death. Conclusions: TVE-based strategies are associated with high angiographic occlusion and favourable functional outcomes in carefully selected bAVMs, but the evidence is predominantly observational and safety estimates remain uncertain. As most patients underwent combined transarterial/transvenous treatment, these findings should not be interpreted as estimates of standalone TVE.