Endovascular Embolization in Neurovascular Disease: Material Science, Multimodal Management, and Future Horizons

Background & Objectives: Endovascular embolization has matured into a sophisticated, precision-guided discipline that is central to the management of complex neurovascular pathologies. This review synthesizes contemporary treatment strategies, evaluating the advanced material characteristics of conventional inert liquid polymers, specifically non-adhesive ethylene vinyl alcohol (EVOH) copolymers and adhesive cyanoacrylates, alongside their targeted clinical applications in brain arteriovenous malformations (bAVMs), dural arteriovenous fistulas (dAVFs), hypervascular intracranial tumors, and chronic subdural hematomas (CSDH). Furthermore, it examines the critical material and hemodynamic constraints that limit these agents in cerebral aneurysm repair. Methods: A comprehensive literature synthesis through mid-2026 was integrated with peer-reviewed clinical illustrations to evaluate both procedural mechanics and the necessity of post-procedural physiological management. Review Findings: Embolization serves a critical dual role: as a definitive curative therapy and as an essential preoperative or radi-osurgical adjunct. As demonstrated by recent clinical validations, technical angiographic success must be closely coupled with vigilant neurocritical oversight to manage profound, localized hemodynamic shifts. The field is rapidly transitioning away from inert me-chanical occlusion toward a highly integrated approach. The convergence of stimu-li-responsive "smart" hydrogels and endovascular robotics promises to transform these interventions into dynamic, bioactive platforms capable of modulating disease-specific mechanisms, such as BMP signaling in bAVMs or the VHL/VEGF axis in hypervascular tumors. This review further analyzes landmark data, including the definitive STEM trial for CSDH, providing a roadmap for translating these advanced material sciences into standardized, multidisciplinary neurointerventional care.