• Giulio Quarta Colosso, Mathilde Aubertin, Emily Rius, Xavier Guerra, Julien Burel, Bertrand Mathon, Aurélien Nouet, Kevin Premat, Mehdi Drir, Julien Allard, Stéphanie Lenck, Nader-Antoine Sourour, Frédéric Clarençon, and Eimad Shotar.
• Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
• Neurosurgery. 2024 Apr 29.

Background And ObjectivesEndovascular embolization of brain arteriovenous malformations (AVMs) is sometimes intentionally partial, in the case of staged treatment for instance. Residual AVMs may be prone to angioarchitectural modification during follow-up. The objective of this work is to evaluate the nature and extent of these modifications.MethodsWe performed a retrospective monocentric study on a cohort of adult patients treated by incomplete endovascular embolization for ruptured and unruptured AVMs with an available angiographic follow-up, without any intervening confounding event between the 2 angiographic examinations. AVM angioarchitectural modifications (arterial, nidal, and venous) were analyzed. Clinical and radiological data were tested in univariate analyses for association with the occurrence of AVM regression or progression.ResultsEighty-two partial embolization sessions in 57 patients were included in the study. A 40% (33/82) rate of modification was found on follow-up, with 23/82 (28%) controls showing at least one angioarchitectural regression feature and 15/82 (18.3%) showing at least one angioarchitectural progression item. Nidal growth was the most frequent modification occurring after 12/82 (14.6%) embolizations. The only factor associated with nidal volume growth was a longer time interval between embolization and follow-up (median [IQR]: 190 [250] days vs 89.5[133] days in the subgroup without nidal growth; P = .02). Specific modifications of arterial supply, nidal anatomy, and venous drainage were identified and documented.ConclusionAngioarchitectural modifications (both progression and regression) of brain AVMs are frequent findings after partial embolization. Nidal volume growth is associated with longer time intervals between embolization and follow-up.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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