Arteriovenous malformation embocure score (AVMES): response

We read with great interest the paper by Lopes et al on the arteriovenous malformation embocure score (AVMES).1 We applaud the authors on this timely paper addressing a central issue in the management of brain arteriovenous malformations (bAVM)—namely, risk stratification for endovascular treatment of these lesions.

In April 2015 we published a paper entitled 'The application of a novel brain arteriovenous malformation endovascular grading scale for transarterial embolization' in the American Journal of Neuroradiology.2 In that retrospective analysis we applied an endovascular grading scale to pretreatment cerebral angiograms in 126 patients treated between 2008 and 2013. Our scale consists of five points that assess three bAVM components: arterial feeders (1–2, 1 point; 3–5, 2 points; ≤6, 3 points, with predominant arterial feeders en passage given a maximal score), eloquence based on Spetzler–Martin criteria (absence=0, presence=1 point), and the presence of an arteriovenous fistula component as...

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