A Randomized Trial of Unruptured Brain AVMs

Inclusion Criteria:

1. Patient must have unruptured BAVM diagnosed by MRI/MRA, CTA and/or angiogram

2. Patient must be 18 years of age or older

3. Patient must have signed Informed Consent, Release of Medical Information, and HealthInsurance Portability and Accountability Act (HIPAA/U.S. only) Forms

Exclusion Criteria:

1. Patient has BAVM presenting with evidence of recent or prior hemorrhage

2. Patient has received prior BAVM therapy (endovascular, surgical, radiotherapy)

3. Patient has BAVM deemed untreatable by local team, or has concomitant vascular orbrain disease that interferes with/or contraindicates any interventional therapy type (stenosis/occlusion of neck artery, prior brain surgery/radiation for other reasons)

4. Patient has baseline Rankin ≥2

5. Patient has concomitant disease reducing life expectancy to less than 10 years

6. Patient has thrombocytopenia (< 100,000/μL),

7. Patient has uncorrectable coagulopathy (INR>1.5)

8. Patient is pregnant or lactating

9. Patient has known allergy against iodine contrast agents

10. Patient has multiple-foci BAVMs

11. Patient has any form of arteriovenous or spinal fistulas Previous diagnosis of any of the following -

12. Patient has a diagnosed Vein of Galen type malformation

13. Patient has a diagnosed cavernous malformation

14. Patient has a diagnosed dural arteriovenous fistula

15. Patient has a diagnosed venous malformation

16. Patient has a diagnosed neurocutaneous syndrome such as cerebro-retinal angiomatosis (von Hippel-Lindau), encephalo-trigeminal syndrome (Sturge-Weber), or Wyburn-Masonsyndrome

17. Patient has diagnosed BAVMs in context of moya-moya-type changes

18. Patient has diagnosed hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber)