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Original research
Endovascular treatment as the main approach for Spetzler–Martin grade III brain arteriovenous malformations
  1. Humain Baharvahdat1,2,
  2. Raphaël Blanc1,
  3. Robert Fahed1,3,
  4. Ashkan Pooyan2,
  5. Ashkan Mowla4,
  6. Simon Escalard1,
  7. François Delvoye1,
  8. Jean Philippe Desilles1,
  9. Hocine Redjem1,
  10. Gabriele Ciccio1,
  11. Stanislas Smajda1,
  12. Mylène Hamdani1,
  13. Mikael Mazighi1,
  14. Michel Piotin1
  1. 1 Department of Interventional Neuroradiology, Fondation de Rothschild, Paris, France
  2. 2 Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
  3. 3 Medicine – Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
  4. 4 Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA


Background Because Spetzler–Martin (SM) grade III brain arteriovenous malformations (bAVMs) constitute a heterogeneous group of lesions with various combination of sizes, eloquence, and venous drainage patterns, their management is usually challenging. The aim of this study is to evaluate the clinical/imaging outcomes and the procedural safety of endovascular approach as the main treatment for the cure of SM grade III bAVMs.

Methods In this retrospective study, prospectively collected data of SM grade III bAVMs treated by endovascular techniques between 2010 and 2018 at our hospital were reviewed. Patients older than 16 years with angiographic follow-up of at least 6 months after endovascular treatment were entered in the study. The patients had a mean follow-up of 12 months. The data were assessed for clinical outcome (modified Rankin Scale), permanent neurological deficit, post-operative complications, and optimal imaging outcome, defined by complete exclusion of AVM. The independent predictive variables of poor outcome or hemorrhagic complication were assessed using binary logistic regression.

Results Sixty-five patients with 65 AVMs were included in the study. Mean age of the patients was 40.0±14.4. Most common presentation was hemorrhage (61.5%). The patients underwent one to eight endovascular procedures (median=2). Mean nidus diameter was 30.2±13.0. A complete obliteration of AVM was achieved in 57 patients (87.7%). Post-procedure significant hemorrhagic and ischemic complications were seen in 13 (20%) and five (7.7%) patients respectively, leading to five (7.7%) transient and four (6.2%) permanent neurological deficits. Eight patients (12.3%) experienced worsening of mRS after embolization. Ten patients (15.4%) had poor outcome (mRS 3–5) at follow-up and two (3%) died.

Conclusions Endovascular treatment can achieve a high rate of complete exclusion of grade III AVM but may be associated (as in other treatment modalities) with significant important complications.

Clinical trial registration number NCT02879071.

  • arteriovenous malformation
  • liquid embolic material
  • hemorrhage
  • intervention

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  • Contributors HB: design, analysis, and preparing the draft. RB: design and supervision of the study and revising draft with final approval. RF: revising critically the draft. AP: acquisition of data and interpretation of data. AM: critically revising the draft. SE: acquisition of data and analysis. FD: acquisition of data. JPD: acquisition of data and interpretation of data. HR: acquisition and analysis of data. GC: acquisition of data. SS: supervision of correct data collection. MH: analysis of data. MM: acquisition of data. MP: design and supervision of the study and final approval of version published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Disclaimer The study protocol was approved by the hospital local ethics committee. There is no conflicting interest for this study. All authors have their own specific responsibility and contribution in one of the following parts of this study: designing/conducting the study, collecting data, analyzing the data, preparing the manuscript, critically revising the draft, approving the final draft, and supervision of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.