{
  "abstract": "Background Most patients with brain arteriovenous malformations (bAVMs) present with or eventually develop symptoms, while facing a persistent risk of rupture. Management remains challenging, and treatment practices continue to evolve. In this study, the safety and efficacy of embolization with the SQUID (BALT Group, Gland,Switzerland) embolic agent, used either as a standalone therapy or in combination with other modalities, were assessed.Methods CHOICE is a prospective, observational, multicenter study conducted at 21 mainly European centers. Adults with previously untreated bAVMs were treated with SQUID, either as embolization alone or before neurosurgery or radiosurgery. The primary endpoint was SQUID- or procedure-related morbidity–mortality, at 3–6 months after last embolization or before further therapy. Secondary endpoints included bAVM occlusion at 3–6 months post-last embolization and safety at 12 months.Results Among the 109 patients included (46.3±15 years, 50.5% male), 80.7% underwent embolization alone and 19.3% had further therapy. Most bAVMs were Spetzler–Martin grade I–II (67%) and <3 cm in diameter (78.9%). Morbidity-mortality related to SQUID and/or procedure at 3–6 months were 11% and 0% respectively, including 6.4% SQUID-related morbidity. At 12 months, these rates were 7.8% and 0% respectively, including 4.9% of SQUID-related morbidity. Complete bAVM occlusion at 3–6 months post-last embolization was achieved in 63.2% in embolization alone patients and 19.0% in patients with embolization before further therapy. The overall complete occlusion rate was 53.6%.Conclusion CHOICE study results suggest good safety and efficacy of SQUID as a standalone treatment or in association with surgical treatment.Trial registration number NCT03413852.",
  "authors": [
    {
      "affiliations": [
        "NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, APHP, Le Kremlin-Bicetre, France",
        "Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France"
      ],
      "name": "Laurent Spelle"
    },
    {
      "affiliations": [
        "Radiology, Odense Hospital, Odense, Denmark"
      ],
      "name": "Gyula Gal"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Pellegrin Hospital, Bordeaux, France"
      ],
      "name": "Xavier Barreau"
    },
    {
      "affiliations": [
        "Neuroradiology, Lariboisière Hospital, Paris, France"
      ],
      "name": "Emmanuel Houdart"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Heidelberg Hospital, Heidelberg, Germany"
      ],
      "name": "Markus A Möhlenbruch"
    },
    {
      "affiliations": [
        "Neuroradiology, Brest Hospital, Brest, France"
      ],
      "name": "Jean Christophe Gentric"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Rouen Hospital, Rouen, France",
        "University of Ioannina, Ioannina, Greece"
      ],
      "name": "Chrisanthi Papagiannaki"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France"
      ],
      "name": "Michel Piotin"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Ghent Hospital, Ghent, Belgium"
      ],
      "name": "Luc Defreyne"
    },
    {
      "affiliations": [
        "Neuroradiology, Saint Anne Hospital, Paris, France"
      ],
      "name": "Denis Trystram"
    },
    {
      "affiliations": [
        "Neuroradiology, Gui de Chauliac Hospital, Montpellier, France"
      ],
      "name": "Alain Bonafé"
    },
    {
      "affiliations": [
        "NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicetre Hospital, APHP, Le Kremlin-Bicetre, France",
        "Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France"
      ],
      "name": "Jildaz Caroff"
    },
    {
      "affiliations": [
        "Diagnostic and Therapeutic Neuroradiology, Pierre Paul Riquet Hospital, Toulouse, France"
      ],
      "name": "Christophe Cognard"
    },
    {
      "affiliations": [],
      "name": "on behalf of the CHOICE Investigators"
    }
  ],
  "title": "SQUID embolization for cerebral AVMs: 1-year safety and efficacy results from the CHOICE prospective multicenter study",
  "uid": "7530d47b-e7f5-5f95-89cb-a0cb7c1d9e6c"
}