Abstract 179: Brain Avm Embolization With Onyx: Clinical And Anatomical Results In A Prospective, Multicenter, European Study (BRAVO)

Abstract

Purpose: The treatment of brain arteriovenous malformations (AVMs) is challenging based on a multidisciplinary approach involving neurosurgery, radiosurgery, and interventional neuroradiology. The embolization of brain AVMS was for a long time performed using particles and glue. Onyx has been recently introduced in the armamentarium for AVM embolization, but large, multicenter evaluation is lacking. BRAVO study was conducted to evaluate the clinical and anatomical results of brain AVM embolization with Onyx. Materials and Methods: BRAVO (Brain ArterioVenous malformations embolization with Onyx) was a multicentric, prospective, consecutive study conducted in 11 neurointerventional centers in Europe. 117 patients harbouring brain AVMs embolized with Onyx were included. Clinical presentation was mostly hemorrhage (30.8%) and epilepsy (27.4%). AVM size was less than 3cm in 52.1% of cases and more than 3cm in 47.9% of cases. A mean number of 2.05 embolization sessions / patient were performed with injection of a mean of 2.4 ml Onyx / session. Results: Complete occlusion was obtained with Onyx embolization alone in a high percentage of cases (23.5% of all cases and 36.7% of AVM smaller than 3cm). Intra and post-operative bleeding related to the treatment was observed in 9.4% leading to death in 3.4% and neurologic worsening in 1.7%. Non-hemorrhagic permanent deficits were observed in 6.0% of cases. Treatment related morbidity (mRS>2) and mortality were respectively 5.1% and 4.3%. Conclusion: Embolization of brain AVMs with Onyx is associated with a high rate of complete occlusion with acceptable morbidity and mortality. Onyx has to be used as the first line embolization agent for the treatment of brain AVMs.