How do you choose between initiating long-term therapy with mTOR inhibitors versus opting for interventional treatments such as embolization or surgery in a patient with tuberous sclerosis, experiencing flank pain, and with renal angiomyolipomas larger than 4 cm?

I have very limited experience, but mTOR has been a game changer for my (2) TS patients.

Why would you wait for bleeding, pain, and embolization if you can prevent it?

This will be a useful article:

Effectiveness and safety of everolimus treatment in patients with tuberous sclerosis complex in real-world clinical practice

I have a young patient with TS, and her rAML >4 cm has been stable ever since starting everolimus.