Introduction Ruptured arteriovenous malformations (AVMs) have an high early re-bleeding risk (6-18%), especially when an aneurysm is identified as the bleeding source. In cases of neither surgical nor endovascular manageable AVMs, Stereotactic RadioSurgery (SRS) becomes the treatment of choice, with 2 to 3 years of latency before it exerts its full effect. During this period patients still have an high hemorrhagic risk if the aneurysm is not treated.

Aim of Study The purpose of this study is to evaluate the safety and efficacy of targeted aneurysm embolization of ruptured AVMs in reducing the early re-bleeding risk.

Methods We retrospectively reviewed 38 ruptured AVMs patients who underwent targeted aneurysm embolization in our Neuroradiology Department between April 2010 and November 2023 and then referred to SRS. Embolization treatments were almost all performed with the use of N-butyl cyanoacrylate (n-BCA) glue, except in one case of coils deployment. The median time period between the embolization and the SRS was 66 days.

Results In 38 cases treated with target aneurysm embolization, we reported 1 adverse event (aneurysm perforation with no clinical worsening),0 early re-bleedings (within 6 months) and 3 re-bleedings at the follow-up (median time 2,6 years), in all cases unrelated to the treated aneurysm.

Conclusion In cases of ruptured AVMs, endovascular occlusion of the bleeding source is a safe treatment, achievable in most of cases and that provides protection from early re-bleeding. In our experience, it is a reasonable strategy for ruptured AVMs management, especially the ones intended to be treated with SRS.