Following the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformation) trial which was performed in 2014 and determined that medical treatment was superior to prophylactic interventional therapy for unruptured arteriovenous malformations (AVMs), the incidence of ruptured AVMs has increased. As a consequence, the rise in cases presenting a new rupture has led to a higher rate of in-hospital mortality [1]. Specifically, in the pediatric population, the most common cause of spontaneous intracerebral hemorrhage (ICH) is AVM rupture. However, it is important and alarming to note that an optimal treatment modality has yet to be completely defined [2], [3], [4].

The management of ruptured AVMs lacks a strict set of treatment principles, but the current practice consists of definitive treatment after ICH stabilization [5]. Some studies have reported that in the general population, definitive endovascular management is an effective and safe technique for cases that present with an early hemorrhagic complication [6], [7], [8]. Additionally, in the setting of high-risk angiographic features that predispose to rupture, embolization has been applied as an adjunct to surgery or radiosurgery to target these high-risk structures before definitive treatment of the remaining portion of the AVM [9]. Nevertheless, recurrence after initial complete AVM obliteration with endovascular management as a stand-alone treatment remains a concern, especially in the pediatric population [3], [10]. Of note, endovascular therapy of ruptured pediatric AVMs is seldomly reported, thus, there is a concerning lack of information about the profile of this therapy as a primary curative approach. Hence, its role remains uncertain.

We consider that identifying the complications related to the procedure as well as determining the complete obliteration rates are relevant outcomes to determine the profile of embolization as a single treatment modality. Hence, we aimed to characterize the safety and efficacy of curative embolization for ruptured AVMs in pediatric patients.