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RESEARCH PRODUCT

Does endovascular treatment with curative intention have benefits for treating High-grade AVM versus radiosurgery? Efficacy, safety, and cost-effectiveness analysis

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BACKGROUND: The treatment of high-grade arteriovenous malformations (AVMs) remains challenging. Microsurgery provides a rapid and complete occlusion compared to other options, but is associated with undesirable morbidity and mortality. The aim of this study was to compare the occlusion rates, incidence of unfavorable outcomes, and cost-effectiveness of embolization and stereotactic radiosurgery (SRS) as a curative treatment for high-grade AVMs.METHODS: A retrospective series of 57 consecutive patients with high-grade AVM treated with embolization or SRS, with the aim of achieving complete occlusion, was analyzed. Demographic, clinical, and angio-architectonic variables were collected. Both treatments were compared for the occlusion rate and procedure-related complications. In addition, a cost-effectiveness analysis was performed.RESULTS: Thirty (52.6%) patients were men and 27 (47.4%) were women (mean age 39 years). AVMs were unruptured in 43 (75.4%) patients, and ruptured in 14 (24.6%) patients. The presence of deep venous drainage, nidus volume, perforated arterial supply, and eloquent localization were more frequent in the SRS group. Complications such as hemorrhage or worsening of previous seizures were more frequent in the embolization group. No significant differences were observed in the occlusion rates or in the time necessary to achieve occlusion between the groups. The incremental cost-effectiveness ratio for endovascular treatment vs. SRS was $ 53.279.CONCLUSION: Both techniques achieved similar occlusion rates, but SRS carried a lower risk of complications. Staged embolization may be associated with a greater risk of hemorrhage, while SRS was demonstrated to have a better cost-effectiveness ratio. These results support SRS as a better treatment option for high-grade AVMs.