Department of Neurosurgery, University of Miami, FL.
Stroke. 2021 Nov;52(11):e710-e714. doi: 10.1161/STROKEAHA.120.033743. Epub 2021 Oct 8.
Since the publication of ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), outcomes in treated and untreated patients with unruptured arteriovenous malformation have been thoroughly compared. However, no prior analysis of ARUBA patients has sought to identify risk factors for perioperative stroke. Improved understanding of risks within the ARUBA cohort will help clinicians apply the study’s findings in a broader context.
The National Institute of Neurological Disorders and Stroke database was queried for all data relating to ARUBA patients, including demographics, interventions undertaken, and timing of stroke. Retrospective cohort analysis was performed with the primary outcome of perioperative stroke in patients who underwent endovascular intervention, and stroke risk was modeled with multivariate analysis.
A total of 64 ARUBA patients were included in the analysis. One hundred and fifty-ninth interventions were performed, and 26 (16%) procedures resulted in stroke within 48 hours of treatment. Posterior cerebral artery supply (adjusted odds ratio, 4.42 [95% CI, 1.23–15.9], P=0.02) and Spetzler-Martin grades 2 and 3 arteriovenous malformation (adjusted odds ratio, 7.76 [95% CI, 1.20–50.3], P=0.03; 9.64 [95% CI, 1.36–68.4], P=0.04, respectively) were associated with increased perioperative stroke risk in patients who underwent endovascular intervention. Patients treated in the United States or Germany had a significantly lower stroke risk than patients treated in other countries (adjusted odds ratio, 0.18 [95% CI, 0.04–0.82], P=0.02).
Knowing patient and lesion characteristics that increase risk during endovascular treatment can better guide clinicians managing unruptured brain arteriovenous malformation. Our analysis suggests risk of perioperative stroke is dependent on Spetzler-Martin grade and posterior-circulation arterial supply. Differences in regional treatment paradigms may also affect stroke risk.
自 ARUBA 试验（未破裂脑动静脉畸形的随机试验）发表以来，对接受治疗和未接受治疗的未破裂动静脉畸形患者的结局进行了全面比较。然而，之前对 ARUBA 患者的分析尚未试图确定围手术期卒中的危险因素。在 ARUBA 队列中更好地了解风险因素将有助于临床医生在更广泛的背景下应用该研究的发现。
国家神经病学与卒中研究所数据库中检索与 ARUBA 患者相关的所有数据，包括人口统计学、进行的干预措施以及卒中发生的时间。对接受血管内干预的患者进行围手术期卒中的主要结局进行回顾性队列分析，并采用多元分析对卒中风险进行建模。
共纳入 64 例 ARUBA 患者进行分析。共进行了 159 次干预，26 次（16%）治疗后 48 小时内发生卒中。后循环动脉供应（调整后的优势比，4.42[95%置信区间，1.23-15.9]，P=0.02）和 Spetzler-Martin 分级 2 级和 3 级动静脉畸形（调整后的优势比，7.76[95%置信区间，1.20-50.3]，P=0.03；9.64[95%置信区间，1.36-68.4]，P=0.04）与接受血管内干预的患者围手术期卒中风险增加相关。在美国或德国接受治疗的患者的卒中风险显著低于在其他国家接受治疗的患者（调整后的优势比，0.18[95%置信区间，0.04-0.82]，P=0.02）。
了解血管内治疗期间增加风险的患者和病变特征可以更好地指导管理未破裂脑动静脉畸形的临床医生。我们的分析表明，围手术期卒中的风险取决于 Spetzler-Martin 分级和后循环动脉供应。区域治疗方案的差异也可能影响卒中风险。
