Kondo Ryushi, Matsumoto Yasushi, Endo Hidenori, Miyachi Shigeru, Ezura Masayuki, Sakai Nobuyuki
Neurol Med Chir (Tokyo). 2014;54 Suppl 2:54-62.
This retrospective study constitutes a part of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2. Its purpose is to evaluate the feasibility, safety, and outcome of endovascular embolization for cerebral arteriovenous malformations (AVMs) in Japan. Nine hundred and eighty-seven embolization procedures were registered with JR-NET 1 and 2 (424 procedures in 122 institutions with JRNET 1 and 563 procedures in 150 institutions with JRNET 2). In total, 790 patients (80.1%) had favourable clinical outcomes defined as modified Rankin Scale (mRS) scores 0–2 at 30 days after embolization. Complete AVM obliteration by embolization alone was achieved in 90 procedures (9.1%). The procedural morbidity and mortality rate was 2.5% and 0.3% per procedure, respectively. In the multivariate logistic regression models, deep venous drainage and embolization of four or more feeding pedicles per session were significantly associated with any treatment-related complications (P=0.02 and P=0.003, respectively). About 6 cm or more in maximum nidus diameter had a negative correlation with complications (P=0.003). Our study shows that embolization of cerebral AVMs was performed with a high degree of safety and a low rate of symptomatic complications in Japan.
这项回顾性研究是日本神经血管内治疗注册研究(JR-NET)1和2的一部分。其目的是评估日本脑动静脉畸形(AVM)血管内栓塞的可行性、安全性和疗效。JR-NET 1和2共登记了987例栓塞手术(JRNET 1中122家机构的424例手术和JRNET 2中150家机构的563例手术)。总共790例患者(80.1%)在栓塞后30天达到了良好的临床结局,定义为改良Rankin量表(mRS)评分为0 - 2分。仅通过栓塞实现AVM完全闭塞的有90例手术(9.1%)。手术的发病率和死亡率分别为每次手术2.5%和0.3%。在多因素逻辑回归模型中,深静脉引流和每次栓塞四个或更多供血蒂与任何治疗相关并发症显著相关(分别为P = 0.02和P = 0.003)。最大病灶直径约6 cm或更大与并发症呈负相关(P = 0.003)。我们的研究表明,在日本,脑AVM栓塞手术的安全性高,有症状并发症发生率低。