Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Internal Medicine, MedStar Georgetown University Hospital/MedStar Washington Hospital Center, Washington, District of Columbia.
Neurosurgery. 2018 Apr 1;82(4):481-490. doi: 10.1093/neuros/nyx230.
Embolization has been discussed as a feasible single modality treatment for intracranial arteriovenous malformations (AVMs).
To compare hemorrhagic risk between embolization and conservative management in a multivariate survival analysis.
We retrospectively reviewed records of patients with intracranial AVMs evaluated at our institution from 1990 to 2013. We included patients recommended to undergo embolization without other treatment modalities and patients managed conservatively. Multivariate Cox regression analysis of hemorrhage-free survival was performed, with the survival interval right-censored to date of either last follow-up or salvage treatment.
We identified 205 patients matching our inclusion criteria, with 160 patients in the noninterventional group and 45 in the embolization group. The average age of all patients was 40.2 ± 19.5 yr, with younger patients undergoing embolization more often (P = .026). Fifty-one (31.9%) conservatively managed patients and 13 (28.9%) patients treated by embolization (P = .703) presented with hemorrhage. Other baseline characteristics were similar between the 2 management groups. During an average follow-up period of 7.7 yr, 30 patients (14.6%) experienced hemorrhage recurrence. Multivariate Cox regression revealed older age (P = .031) and hemorrhagic presentation (P < .001) to be statistically associated with follow-up hemorrhage. In a subset analysis of unruptured AVMs, embolization was associated with a 4-fold hazard ratio of hemorrhage compared to conservative management (P = .044).
Older age and initial presentation with hemorrhage were associated with increased risk of hemorrhage during follow-up. Treatment of AVMs with embolization as the sole modality may increase hemorrhagic risk compared with conservative management, especially in unruptured AVMs.
栓塞已被讨论为治疗颅内动静脉畸形（AVM）的一种可行的单一治疗方法。
在多变量生存分析中比较栓塞与保守治疗的出血风险。
我们回顾性分析了 1990 年至 2013 年在我们机构评估的颅内 AVM 患者的记录。我们纳入了建议接受栓塞而不采用其他治疗方法的患者和接受保守治疗的患者。对无出血生存的多变量 Cox 回归分析进行了分析，生存间隔右删失至最后随访或挽救治疗的日期。
我们确定了 205 名符合纳入标准的患者，其中 160 名患者在非介入组，45 名患者在栓塞组。所有患者的平均年龄为 40.2±19.5 岁，年轻患者更常接受栓塞治疗（P=0.026）。51 名（31.9%）接受保守治疗的患者和 13 名（28.9%）接受栓塞治疗的患者（P=0.703）出现了出血。两组治疗组的其他基线特征相似。在平均 7.7 年的随访期间，有 30 名患者（14.6%）出现出血复发。多变量 Cox 回归显示，年龄较大（P=0.031）和出血表现（P<0.001）与随访出血有统计学关联。在未破裂 AVM 的亚组分析中，与保守治疗相比，栓塞治疗与出血风险增加 4 倍相关（P=0.044）。
年龄较大和首发表现为出血与随访期间出血风险增加相关。与保守治疗相比，栓塞作为唯一治疗方法治疗 AVM 可能会增加出血风险，尤其是在未破裂的 AVM 中。
