Jin Hengwei, Jiang Yuhua, Ge Huijian, Luo Jing, Li Conghui, Wu Hongxing, Li Youxiang
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, People's Republic of China.
Neurosurgery Department, First Affiliated Hospital of Anhui Medical University, Anhui, People's Republic of China.
World Neurosurg. 2017 Oct;106:394-401. doi: 10.1016/j.wneu.2017.07.020. Epub 2017 Jul 14.
Several scales have been proposed for risk assessment and outcome determination in brain arteriovenous malformations treated by endovascular therapy. We aim to validate and compare the efficacy of these scales in predicting perioperative complications and clinical outcomes.
We retrospectively reviewed brain arteriovenous malformations patients who underwent endovascular therapy at 4 centers in China from January 2012 to December 2015. The primary outcomes were complications, unfavorable outcome (mRS ≥ 3), and complete obliteration. Each patient was assessed using the Spetzler-Martin grading system (SM), Puerto Rico scale, Buffalo score, and arteriovenous malformation embocure score (AVMES). Correlation analysis was performed between primary outcomes incidence rate and the grades of each scale. The area under the receiver operating characteristic curve of these scales was calculated. Pairwise comparison of receiver operating characteristic curves was performed to compare the efficacy of the scales.
A total of 270 patients were included. Correlation analysis demonstrated that the complication rate increased with increasing grade in SM (P = 0.002), Puerto Rico scale (P = 0.014), and Buffalo score (P = 0.001); complete obliteration rate decreased with increasing grade in AVMES (P = 0.017); unfavorable outcome rate increased with increasing grade in the Puerto Rico scale (P = 0.005). The area under the receiver operating characteristic curve analysis showed statistical differences between the Puerto Rico score and SM (P = 0.047) in predicting complications and between the Puerto Rico score and SM (P = 0.008) in predicting unfavorable outcomes. The area under the curve of the AVMES in predicting complete obliteration was 0.757.
The Puerto Rico score predicts complications and unfavorable outcomes better than the SM. The AVMES scale has medium efficacy in predicting complete obliteration.
已提出多种量表用于经血管内治疗的脑动静脉畸形的风险评估和预后判定。我们旨在验证并比较这些量表在预测围手术期并发症和临床结局方面的有效性。
我们回顾性分析了2012年1月至2015年12月在中国4个中心接受血管内治疗的脑动静脉畸形患者。主要结局指标为并发症、不良结局（改良Rankin量表评分≥3分）和完全闭塞。使用斯佩茨勒 - 马丁分级系统（SM）、波多黎各量表、布法罗评分和动静脉畸形栓塞评分（AVMES）对每位患者进行评估。对主要结局发生率与各量表分级进行相关性分析。计算这些量表的受试者操作特征曲线下面积。对受试者操作特征曲线进行两两比较以比较量表的有效性。
共纳入270例患者。相关性分析表明，在SM量表（P = 0.002）、波多黎各量表（P = 0.014）和布法罗评分（P = 0.001）中，并发症发生率随分级增加而升高；在AVMES中，完全闭塞率随分级增加而降低（P = 0.017）；在波多黎各量表中，不良结局发生率随分级增加而升高（P = 0.005）。受试者操作特征曲线下面积分析显示，在预测并发症方面，波多黎各评分与SM量表之间存在统计学差异（P = 0.047）；在预测不良结局方面，波多黎各评分与SM量表之间存在统计学差异（P = 0.008）。AVMES在预测完全闭塞方面的曲线下面积为0.757。
波多黎各评分在预测并发症和不良结局方面优于SM量表。AVMES量表在预测完全闭塞方面具有中等有效性。
