1Department of Neurological Surgery, University of Texas Southwestern, School of Medicine; and.
Departments of2Neurological Surgery and.
J Neurosurg. 2020 Feb 1;132(2):388-399. doi: 10.3171/2018.10.JNS181791. Epub 2019 Feb 1.
Endovascular embolization has been established as an adjuvant treatment strategy for brain arteriovenous malformations (AVMs). A growing body of literature has discussed curative embolization for select lesions. The transition of endovascular embolization from an adjunctive to a definitive treatment modality remains controversial. Here, the authors reviewed the literature to assess the lesional characteristics, technical factors, and angiographic and clinical outcomes of endovascular embolization of AVMs with intent to cure.
Electronic databases-Ovid MEDLINE, Ovid Embase, and PubMed-were searched for studies in which there was evidence of AVMs treated using endovascular embolization with intent to cure. The primary outcomes of interest were angiographic obliteration immediately postembolization and at follow-up. The secondary outcomes of interest were complication rates. Descriptive statistics were used to calculate rates and means.
Fifteen studies with 597 patients and 598 AVMs treated with intent-to-cure embolization were included in this analysis. Thirty-four percent of AVMs were Spetzler-Martin grade III. Complete obliteration immediately postembolization was reported in 58.3% of AVMs that had complete treatment and in 45.8% of AVMs in the entire patient cohort. The overall clinical complication rate was 24.1%. The most common complication was hemorrhage, occurring in 9.7% of patients. Procedure-related mortality was 1.5%.
While endovascular embolization with intent to cure can be an option for select AVMs, the reported complication rates appear to be increased compared with those in studies in which adjunctive embolization was the goal. Given the high complication rate related to a primary embolization approach, the risks and benefits of such a treatment strategy should be discussed among a multidisciplinary team. Curative embolization of AVMs should be considered an unanticipated benefit of such therapy rather than a goal.
血管内栓塞已被确立为脑动静脉畸形（AVM）的辅助治疗策略。越来越多的文献讨论了选择性病变的治愈性栓塞。血管内栓塞从辅助治疗向确定性治疗方式的转变仍然存在争议。在这里，作者回顾了文献，以评估有治愈意图的 AVM 血管内栓塞的病变特征、技术因素以及血管造影和临床结果。
电子数据库——Ovid MEDLINE、Ovid Embase 和 PubMed 被用来搜索有证据表明使用有治愈意图的血管内栓塞治疗 AVM 的研究。主要观察指标是栓塞后即刻和随访时的血管造影闭塞情况。次要观察指标是并发症发生率。使用描述性统计计算率和平均值。
本分析纳入了 15 项研究，共 597 名患者和 598 例接受有治愈意图栓塞治疗的 AVM。34%的 AVM 为 Spetzler-Martin 分级 III 级。完全治疗的 AVM 中有 58.3%在栓塞后即刻完全闭塞，整个患者队列中 AVM 的比例为 45.8%。总的临床并发症发生率为 24.1%。最常见的并发症是出血，发生率为 9.7%。与该治疗策略相关的程序性死亡率为 1.5%。
虽然有治愈意图的血管内栓塞可以作为某些 AVM 的选择，但与辅助栓塞治疗为目标的研究相比，报告的并发症发生率似乎更高。鉴于与原发性栓塞方法相关的高并发症率，应在多学科团队中讨论这种治疗策略的风险和益处。应将 AVM 的治愈性栓塞视为该治疗的意外获益，而不是治疗目标。
