Evaluating the safety and efficacy of transvenous embolization for brain arteriovenous malformation: A systematic review and meta-analysis.

BACKGROUND: Transvenous embolization is a potential therapy for brain arteriovenous malformation, involving the use of microcatheters to guide an ethylene vinyl alcohol coil for vessel occlusion. However, the safety and efficacy of transvenous embolization are not fully established.

OBJECTIVE: To evaluate the safety and efficacy of transvenous embolization for brain arteriovenous malformation.

METHODS: A systematic review of the literature of studies investigating the safety and efficacy of transvenous embolization for brain arteriovenous malformation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases, including PubMed, Cochrane Library, Web of Science, and Embase were queried.

RESULTS: In the final analysis of 16 studies involving 368 brain arteriovenous malformation cases who received transvenous embolization, the complete occlusion was achieved in 91% (95% CI: 88%, 94%; I 2  = 43%, p  = 0.04) of cases. The overall rate of good outcomes after discharge was high at 89% (95% CI: 82%, 95%; I 2  = 60%, p  < 0.01). Ischemic complications were reported in 1% of cases (95% CI: 0%, 2%; I 2  = 0%, p  = 0.96), while hemorrhagic complications occurred in 6% of cases (95% CI: 3%, 8%; I 2  = 8%, p  = 0.37), and technical complications rate of 8% (95% CI: 4%, 11%; I 2  = 8%, p  = 0.36). Finally, only one death was related to the procedure.

CONCLUSION: Transvenous embolization for brain arteriovenous malformation shows promising safety and effectiveness, with low mortality, a considerable rate of positive outcomes, and a relatively low incidence of complications. The majority of patients achieved complete occlusion, indicating transvenous embolization as a potential option, especially for challenging deep-seated lesions.