Long-term efficacy and safety of curative embolization of brain arteriovenous malformations using the dual microcatheter technique: A single-institution case series and literature review.

[OBJECTIVE] Brain arteriovenous malformations (bAVMs) are among the most common causes of cerebral hemorrhage in adolescents. For multiple-feeder bAVMs, complete exclusion of the nidus by endovascular embolization is challenging. This case series and literature review examined the long-term efficacy and safety of bAVM embolization using the dual microcatheter technique (DMCT).

[METHODS] A total of 38 consecutive patients who underwent endovascular treatment for bAVMs with the DMCT along with all cases reported in the literature were retrospectively reviewed. Patient demographics, clinical presentation, bAVM angioarchitecture, treatment, complications, and long-term outcome were independently assessed.

[RESULTS] Patients with bAVM (24 male and 14 female, mean age: 33.87 ± 13.70 years) treated at our institution were followed up for 97.76 ± 14.51 months. Angiographic obliteration was achieved in a single embolization session in 27/38 (71.05 %) cases; 4/38 (10.53 %) required multiple sessions, and 7/38 (18.42 %) underwent embolization combined with microsurgery or radiotherapy. Neurologic improvement at 90 days was observed in 29/38 patients (76.32 %). At the final follow-up, 34/38 patients (89.47 %) had a favorable clinical outcome. Two patients experienced recurrence during the follow-up period. In total, 55 patients were ultimately analyzed in our literature review. Complete exclusion of bAVMs was achieved in 35 patients (63.63 %), including in 54.54 % after a single endovascular treatment session. One patient died of hemorrhagic complication after endovascular treatment for an overall mortality rate of 1.82 %.

[CONCLUSIONS] DMCT is safe for bAVM embolization and shows long-term efficacy, especially for multiple-feeder bAVMs.