Clinical Trial

. 2025 Jun;56(6):1396-1403.

doi: 10.1161/STROKEAHA.124.049109. Epub 2025 Mar 27.

Transvenous Approach for the Treatment of Cerebral Arteriovenous Malformations: A Randomized Comparison With Transarterial Embolization

Jean Raymond¹, Tim E Darsaut², Suzana Saleme³, Aymeric Rouchaud³, Daniela Iancu¹, Daniel Roy¹, Alain Weill¹, Leonardo Olijnyk¹, Roland Jabre⁴, Michel W Bojanowski⁴, Chiraz Chaalala⁴, David Roberge⁵, Kamel Boubagra⁶, Olivier Heck⁶, Jeremy L Rempel⁷, Chrysanthi Papagiannaki⁸, Xavier Barreau⁹, Gaultier Marnat⁹, Jean-Christophe Gentric¹⁰, Julien Ognard¹⁰, Lorena Nico¹¹, Marc Bintner¹², Pascale Gauthier Lasalarie¹², Jean-Brice Veyrieres¹², Michel Piotin¹³, Simon Escalard¹³, Vitor M Pereira¹⁴, Daniel G Abud¹⁵, Justine Zehr¹⁶, Miguel Chagnon¹⁶, Thanh N Nguyen¹⁷, David Mathieu¹⁸, Guylaine Gevry¹⁹, Ruby Klink¹⁹, Emmanuelle Lorian³, Charbel Mounayer³; TATAM Collaborative Group

Collaborators, Affiliations

Collaborators

Affiliations

¹ Department of Radiology, Service of Neuroradiology (J.R., D.I., D. Roy, A.W., L.O.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
² Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada (T.E.D.).
³ Neuroradiology Department, University Hospital of Limoges, Dupuytren, France (S.S., A.R., E.L., C.M.).
⁴ Division of Neurosurgery, Department of Surgery (R.J., M.W.B., C.C.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
⁵ Division of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (D. Roberge), University of Montreal, Quebec, Canada.
⁶ Département de Neuroradiologie Interventionnelle, CHU Grenoble, France (K.B., O.H.).
⁷ Department of Radiology, University of Alberta Hospital, Edmonton, Canada (J.L.R.).
⁸ Département de Neuroradiologie Interventionnelle, CHU Rouen, France (C.P.).
⁹ Service de Neuroradiologie Interventionnelle, CHU de Bordeaux, France (X.B., G.M.).
¹⁰ Department of Interventional Neuroradiology, CHU Cavale Blanche, Inserm, UMR 1304 (GETBO), Brest, France (J.-C.G., J.O.).
¹¹ Department of Neuroradiology, University Hospital of Padova, Italy (L.N.).
¹² Département de Neuroradiologie Interventionnelle, CHU de la Réunion, France (M.B., P.G.L., J.-B.V.).
¹³ Service de Neuroradiologie Interventionnelle, Fondation Adolphe de Rothschild, Paris, France (M.P., S.E.).
¹⁴ Department of Neurosurgery and Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario, Canada (V.M.P.).
¹⁵ Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil (D.G.A.).
¹⁶ Department of Mathematics and Statistics (J.Z., M.C.), University of Montreal, Quebec, Canada.
¹⁷ Department of Neurology and Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA (T.N.N.).
¹⁸ Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke, Quebec, Canada (D.M.).
¹⁹ Interventional Neuroradiology Research Unit, Centre de recherche de l'Université de Montréal, Unité de recherche clinique NRI, Quebec, Canada (G.G., R.K.).

PMID: 40143818
DOI: 10.1161/STROKEAHA.124.049109

Clinical Trial

Transvenous Approach for the Treatment of Cerebral Arteriovenous Malformations: A Randomized Comparison With Transarterial Embolization

Jean Raymond et al. Stroke. 2025 Jun.

. 2025 Jun;56(6):1396-1403.

doi: 10.1161/STROKEAHA.124.049109. Epub 2025 Mar 27.

Authors

Collaborators

Affiliations

¹ Department of Radiology, Service of Neuroradiology (J.R., D.I., D. Roy, A.W., L.O.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
² Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada (T.E.D.).
³ Neuroradiology Department, University Hospital of Limoges, Dupuytren, France (S.S., A.R., E.L., C.M.).
⁴ Division of Neurosurgery, Department of Surgery (R.J., M.W.B., C.C.), Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
⁵ Division of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (D. Roberge), University of Montreal, Quebec, Canada.
⁶ Département de Neuroradiologie Interventionnelle, CHU Grenoble, France (K.B., O.H.).
⁷ Department of Radiology, University of Alberta Hospital, Edmonton, Canada (J.L.R.).
⁸ Département de Neuroradiologie Interventionnelle, CHU Rouen, France (C.P.).
⁹ Service de Neuroradiologie Interventionnelle, CHU de Bordeaux, France (X.B., G.M.).
¹⁰ Department of Interventional Neuroradiology, CHU Cavale Blanche, Inserm, UMR 1304 (GETBO), Brest, France (J.-C.G., J.O.).
¹¹ Department of Neuroradiology, University Hospital of Padova, Italy (L.N.).
¹² Département de Neuroradiologie Interventionnelle, CHU de la Réunion, France (M.B., P.G.L., J.-B.V.).
¹³ Service de Neuroradiologie Interventionnelle, Fondation Adolphe de Rothschild, Paris, France (M.P., S.E.).
¹⁴ Department of Neurosurgery and Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario, Canada (V.M.P.).
¹⁵ Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil (D.G.A.).
¹⁶ Department of Mathematics and Statistics (J.Z., M.C.), University of Montreal, Quebec, Canada.
¹⁷ Department of Neurology and Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, MA (T.N.N.).
¹⁸ Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke, Quebec, Canada (D.M.).
¹⁹ Interventional Neuroradiology Research Unit, Centre de recherche de l'Université de Montréal, Unité de recherche clinique NRI, Quebec, Canada (G.G., R.K.).

PMID: 40143818
DOI: 10.1161/STROKEAHA.124.049109

Abstract

Background: Transvenous embolization (TVE) is a new treatment of brain arteriovenous malformations (AVMs). The safety and efficacy of TVE have not been compared with transarterial embolization (TAE). The primary hypothesis of this trial was that TVE would increase the proportion of AVM occlusion from 40% to 80%.

Methods: The TATAM (Transvenous Approach for the Treatment of Cerebral AVMs) was an investigator-initiated, multicenter, prospective, phase 2, open-label, controlled randomized trial comparing TVE versus TAE alone (1:1). Patients with symptomatic or asymptomatic AVMs considered curable with 2 endovascular sessions were reviewed by a case selection committee. Participating centers were experienced (>20 cases) or proctored by experts. The primary outcome was complete occlusion of the AVM, confirmed by catheter angiography at 3 to 6 months. There was no blinding. Primary analyses were intent-to-treat.

Results: From May 2019 to April 2023, 77 patients were recruited in 7 French and 2 Canadian centers. After exclusions, results from 69 patients were analyzed; 35 were allocated TVE and 34 TAE. The mean age of participants was 43.3 years; 29 of 69 (42%) were female. There were 2 crossovers. The primary outcome was reached in 29 of 35 patients with TVE (83% [95% CI, 67%-92%]) compared with 20 of 34 patients allocated TAE (59% [95% CI, 42%-74%]; P=0.036). Poor outcomes (modified Rankin Scale score >2 at 3-6 months) occurred in 7 of 35 patients with TVE (20% [95% CI, 10%-36%]) and 9 of 34 patients with TAE (27% [95% CI, 15%-43%]; P=0.578) and related serious adverse events in 12 of 35 patients with TVE (34% [95% CI, 21%-51%]) and 14 of 34 patients with TAE (41% [95% CI, 26%-58%]; P=0.624).

Conclusions: TVE was more effective than TAE in terms of angiographic results at 3 to 6 months. Morbidity was similar but high for both groups. More studies are needed to determine the role of curative embolization in managing patients with brain AVM.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03691870.

Keywords: brain; intracranial arteriovenous malformations; intracranial hemorrhages; morbidity.

PubMed Disclaimer

Conflict of interest statement

Dr Rouchaud reports compensation from MicroVention, Inc, for consultant services and compensation from Balt USA, LLC, for consultant services. Dr Iancu reports compensation from Balt SAS, Stryker, and MicroVention, Inc, for consultant services. Dr Roberge reports compensation from AstraZeneca Canada, F. Hoffmann-La Roche, Novocure, Inc, Recordati Rare Diseases, Inc, and Accuray Incorporated for consultant services and securities holdings in MisoChip and AFX Medical. Dr Rempel reports compensation from Penumbra, Inc, Rapid Medical Ltd, and Vena for consultant services. Dr Barreau reports compensation from MicroVention, Inc, Balt Group, and Stryker Corporation for consultant services. Dr Marnat reports compensation from Stryker, Balt USA, LLC, and MicroVention, Inc, for consultant services and compensation from Phenox, Inc, Johnson & Johnson Medical Devices & Diagnostics Group-Latin America, LLC, Penumbra, Inc, Bracco Imaging, and Medtronic for other services. Dr Gentric reports compensation from Phenox, Inc, Stryker, Balt USA, LLC, and Medtronic for consultant services. Dr Ognard reports grants from Société Française de Neuroradiologie (SFNR), Philips, Servier Affaires Medicales, Innoveo, Philippe Foundation, Medtronic, and GIRCI GO; travel support from Phenox, Inc; and compensation from Balt USA, LLC, for consultant services. Dr Piotin reports stock holdings in Basecamp Vascular. Dr Escalard reports compensation from BCV Systems for consultant services. Dr Pereira reports compensation from Stryker, Balt USA, LLC, and Medtronic for consultant services. Dr Nguyen reports compensation from the American Stroke Association, Genentech, and Kaneka for other services and compensation from Aruna and Brainomix for consultant services. Dr Mounayer reports compensation from Medtronic, MicroVention, Inc, and Balt USA, LLC, for consultant services. The other authors report no conflicts.

Cited by

Thalamic Arteriovenous Malformations: Clinical Presentation, Angio-Architecture and Therapeutic Management: Retrospective Analysis of a Single Center Experience in 22 Patients.
Chiaroni PM, Delaître M, Shotar E, Mathon B, Sourour NA, Allard J, Premat K, Elhorany M, Boch AL, Borius PY, Lenck S, Degos V, Carpentier A, Clarençon F. Chiaroni PM, et al. Clin Neuroradiol. 2025 Aug 29. doi: 10.1007/s00062-025-01558-9. Online ahead of print. Clin Neuroradiol. 2025. PMID: 40879747

Publication types

Actions
Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Transvenous Approach for the Treatment of Cerebral Arteriovenous Malformations: A Randomized Comparison With Transarterial Embolization

Collaborators

Affiliations

Transvenous Approach for the Treatment of Cerebral Arteriovenous Malformations: A Randomized Comparison With Transarterial Embolization

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous

Abstract

Conflict of interest statement

Similar articles

Cited by

Publication types

MeSH terms

Associated data

Related information

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous