AVM is a mass of abnormally developed blood vessels containing arterioles and venules with direct arteriovenous connections in multiple locations, without intervening capillary intervals, and varying in size. AVMs can occur in all parts of the brain, most often at the junction of the cortex and white matter, and are mostly cone-shaped, with the broad base located in the cortex and the tip pointing to the white matter. 90% of AVMs are located in the supratentorial area and 10% in the infratentorial area, with the parietal lobe being the most common in the supratentorial area, accounting for about 30%, followed by 22% in the temporal lobe, 21% in the frontal lobe, and 10% in the occipital lobe. AVM has the characteristics of low arterial pressure and high venous pressure due to direct arteriovenous traffic. Low arterial pressure causes insufficient blood supply to the brain tissue in its blood supply area, and prolonged “blood theft” can cause atrophy of the surrounding brain tissue. Meanwhile, high venous pressure can cause poor reflux of brain tissue in the corresponding area, resulting in local bruising and cerebral edema, as well as disturbance of cerebrospinal fluid absorption and secretion, which can lead to symptoms of cranial hypertension, and because the tissue structure of venous blood vessel wall is weaker and less elastic than that of arterial blood vessel wall, the increase of venous pressure can make it easier to rupture and bleed. The clinical symptoms and signs of cerebral AVM mainly include: 1. headache, patients may have long-term chronic headache, mainly due to the stimulation of meninges caused by abnormal development of AVM and cranial hypertension. In case of hemorrhage, there may be severe headache. 2. Hemorrhage, which mostly occurs in younger patients, may manifest as SAH, intracerebral hemorrhage, or subdural hemorrhage, and commonly occurs in patients with severe headache, vomiting, and cervical tonicity during heavy exercise or mood swings. The mortality rate after the first bleeding is about 1/3, the second is double up to 2/3, and the third bleeding has little chance of survival. 3, epilepsy, epilepsy as the first symptom of cerebral AVM, mainly due to the short circuit of the arteries and veins of cerebral AVM, arterial blood flow directly into the venous system without circulation, the so-called “blood theft” phenomenon, so that the deformed vascular mass around the brain cells insufficient blood supply, resulting in seizures, in addition, the local cerebral edema caused by poor venous reflux, is also is one of the causes. The incidence of epilepsy is related to the size, location and type of AVM. In general, AVMs that are large and more diffuse and located in the frontoparietal lobe are more likely to have abnormal discharges in brain tissue, leading to epilepsy. Progressive neurological deficits, mainly motor or sensory paresis, are less common as the first symptom, about 10%, due to cerebral ischemic attacks and local brain atrophy and cerebral edema caused by “blood theft”. 5, intracranial murmur, the patient can feel the scalp or intracranial flutter and murmur, which can often be found during auscultation. These AVMs are often large and superficial in location, and often have a fast blood flow rate and obvious arteriovenous short-circuiting phenomenon. In addition, AVMs in the cavernous sinus region may have protruding eyes due to increased ophthalmic venous pressure. Long-term epilepsy and cerebral ischemia and atrophy can cause mental retardation. In addition to spontaneous SAH, some posterior cranial fossa symptoms, such as cerebellar ataxia and posterior group cranial nerve palsy, which occur less frequently, are often rare or asymptomatic. CT and MRI manifestations: CT scan often shows only indirect signs such as focal brain atrophy, localized mild cerebral edema, or even no positive findings, but when the above signs are found on CT scan, especially in patients with a history of epilepsy, cerebral AVM should be highly suspected; CT enhancement can be seen in the sign area found on the corresponding scan with earthworm-like or mixed uneven masses of high enhancement, and even abnormal thickening can be distinguished. MRI is undoubtedly much superior to CT in terms of displaying the structure of the lesion and the relationship between the lesion and the surrounding brain tissue. In addition, the recent application of 3D CT and MRI vascular imaging technology has greatly improved the diagnosis of AVM by CT and MRI, but so far, for the diagnosis of AVM, DSA whole brain angiography still has a greater advantage and is called the “gold standard”, mainly because DSA DSA whole brain angiography can selectively image the blood vessels, and dynamically observe the blood supply and drainage of the malformed vascular mass, the specific structure and flow rate in the malformed vascular mass to prepare for the next step of treatment. In addition, the digital image acquisition of DSA has higher resolution than the probe and coil acquisition of CT and MRI, and its ability to distinguish the fine structure of blood vessels is higher than that of CT and MRI. Brain Interventional imaging and treatment of AVM: In the past, the treatment of AVM in the brain mainly consisted of surgical resection and conservative medical treatment. In recent years, with the development of science and technology, minimally invasive treatments such as gamma knife and endovascular interventions have emerged, enriching the treatment methods and representing a trend of international medical treatment for minimally invasive diseases. Here, we will focus on the endovascular interventional treatment of cerebral AVM. Interventional neuroradiotherapy for cerebral AVM has the advantages of less trauma, less relative risk, fewer sequelae, and faster postoperative recovery, but it also has the disadvantages of higher cost and more difficult to completely eradicate in patients with certain pathological conditions, and now it is often advocated to use multiple means of combined treatment. The premise of cerebral AVM interventional treatment is firstly that the vascular images must be carefully read first to fully understand its structure in order to select the embolization treatment plan in a targeted manner, to achieve the scientific and safety of the plan, to treat more accurately and perfectly, and to save patients from pain and recover as soon as possible. Cerebrovascular malformation cluster is actually an abnormal vascular cluster with complex structure. In recent years, some domestic and foreign experts have used an architectural term–architectures, to describe it, because, the internal structure of malformation vascular cluster is like a building, its walls have load-bearing and non-load-bearing, with This requires us to carefully analyze and study the internal structure in advance to make accurate judgments, and in addition, to consider the problem of blood flow changes after embolization. The embolization of cerebral AVM firstly needs to exclude bleeding-prone factors, which include the presence of deep venous drainage in the malformed vessels, the presence of rupture-prone aneurysms contained in the malformed mass, and the presence of fistulas with fast flow rates. Secondly, the effectiveness of embolization needs to be considered. Effective embolization can reduce the recanalization rate of the aberrant mass, and embolization must be performed within the aberrant mass to be effective. In conclusion, the embolization of AVM should be carried out for the first time with a more scientific plan, which artery to start with, and then, how to carry out the embolization step by step, should be considered in a comprehensive manner. The diagnosis of cerebral AVM on cerebral angiography is not difficult, but it is necessary to see thickened blood supply arteries, malformed vascular masses and early draining veins with fast flow rate, and the arteriovenous and venous sinus can sometimes appear on the same frame, and the venous sinus will appear twice after the normal part of vascular circulation is finished. According to Professor Ling Feng’s classification, there are five types of vascular constructions: terminal; transmural; direct arteriovenous fistula; concomitant aneurysm; and concomitant venous dilatation. AVMs in the brain are generally imaged according to Spetzler’s scoring criteria, i.e., 1 point for those located in functional areas, 1 point for those with deep venous drainage, 1 point for those with a malformed mass less than 3 CM in diameter, 2 points for those with 3 – 6 CM, and 3 points for those with more than 6 CM. The cumulative total of the above scores is divided into five levels. The degree of difficulty of treatment is increased accordingly. Interventional treatment of AVM is mainly based on embolization of the malformed vascular mass. Although there are various ways of embolization, the basic method is the same, which is to use the microcatheter built into the guiding catheter and inject the embolic material into the malformation mass through the blood supply artery of AVM, only the embolic material used is different. It is also the most commonly used internationally. The operation is best performed under general anesthesia, which can keep the patient in a quiet state and avoid accidents due to the increase of blood pressure caused by agitation, and the surgeon can also complete the operation in a stable state. During and after the treatment, the patient should have blood pressure lowered to prevent the breakthrough of perfusion pressure, and some anticoagulation should be given to prevent reverse thrombosis.