Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Assistance publique-hôpitaux de Marseille, Hôpital de la Timone, Service d'imagerie diagnostic et interventionnelle, Marseille, France; Laboratoire d'imagerie interventionnelle expérimentale (LIIE), Faculté de Médecine, CERIMED, Université Aix-Marseille Marseille, France.
J Vasc Interv Radiol. 2024 Mar;35(3):349-360. doi: 10.1016/j.jvir.2023.11.018. Epub 2023 Nov 25.
To compare the safety, effectiveness, and persistence rates of 0.018-inch coils with those of Amplatzer vascular plugs (AVPs; Abbott Vascular, Abbott Park, Illinois) for the treatment of pulmonary arteriovenous malformations (PAVMs) in response to a growing concern that 0.018-inch coil embolization would increase the long-term persistence rate.
This is a retrospective, single-center study of a database (2002-2020) of 633 PAVM embolizations. Complex PAVMs and those not embolized with 0.018-inch coils or plugs were excluded. PAVM embolization material was classified into 4 groups: (a) 0.018-inch nonfibered coils (NFCs), (b) 0.018-inch fibered coils (FCs), (c) NFCs and FCs, or (d) plugs. Persistence was defined as flow through the PAVM on digital subtraction angiography (DSA) or as <30% diameter reduction of the aneurysmal sac on unenhanced computed tomography (CT). Kaplan-Meier analysis and Cox regression were used to assess PAVM's persistence-free survival.
A total of 312 PAVM embolizations with NFCs (43 PAVMs), FCs (127 PAVMs), NFCs and FCs (12 PAVMs), or plugs (130 PAVMs) in 109 patients (28% men; mean age = 49 years) were included. All PAVM embolizations were technically successful without any major adverse events. PAVM persistence-free survival rates at 10 years' follow-up were 40.8% versus 44.7% in the NFC and FC groups (P = .22) and 47.3% versus 81.0% in the 0.018-inch coil (NFC or FC) and plug groups (P < .0001), respectively. There were 0.43 (79/182) and 0.08 (10/130) re-embolization procedures per PAVM in the 0.018-inch coil and plug groups, respectively (P < .001).
PAVM embolization with 0.018-inch coils was safe, but persistence rate with PAVM embolization was significantly higher than that with plugs, with no significant differences between FCs and NFCs.
比较 0.018 英寸线圈与 Amplatzer 血管塞（AVP；雅培血管，雅培公园，伊利诺伊州）治疗肺动静脉畸形（PAVM）的安全性、有效性和持久性，因为越来越多的人担心 0.018 英寸线圈栓塞会增加长期持久性。
这是一项回顾性、单中心研究数据库（2002-2020 年）的 633 例 PAVM 栓塞。排除复杂 PAVM 及未用 0.018 英寸线圈或塞子栓塞的 PAVM。PAVM 栓塞材料分为 4 组：（a）0.018 英寸非纤维线圈（NFCs），（b）0.018 英寸纤维线圈（FCs），（c）NFCs 和 FCs，或（d）塞子。持久性定义为数字减影血管造影（DSA）上的 PAVM 血流通过或未增强 CT（CT）上的动脉瘤囊直径减少<30%。Kaplan-Meier 分析和 Cox 回归用于评估 PAVM 无持续性生存。
共纳入 109 例患者（28%为男性；平均年龄为 49 岁）的 312 例 PAVM 栓塞术，包括 NFCs（43 例 PAVM）、FCs（127 例 PAVM）、NFCs 和 FCs（12 例 PAVM）或塞子（130 例 PAVM）。所有 PAVM 栓塞均无技术失败，无重大不良事件。10 年随访时，无持续性生存 PAVM 栓塞术分别为 NFC 组和 FC 组 40.8%和 44.7%（P=0.22），0.018 英寸线圈（NFC 或 FC）和塞子组 47.3%和 81.0%（P<0.0001）。0.018 英寸线圈组每例 PAVM 分别有 0.43（79/182）和 0.08（10/130）次再栓塞术（P<0.001）。
0.018 英寸线圈 PAVM 栓塞术安全，但 PAVM 栓塞术的持久性明显高于塞子，FCs 和 NFCs 之间无显著差异。
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