脑动静脉畸形治疗性栓塞的长期并发症及预后：一项系统评价
Long-term complications and outcomes of therapeutic embolization of cerebral arteriovenous malformations: a systematic review.
作者信息
Lúcio Vivianne Beatriz Dos Santos, Queiroz Vinício Rufino, Lins Cícero José Pacheco, Baggio Jussara Almeida de Oliveira, Souza Carlos Dornels Freire de
机构信息
Undergraduate Student, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
Neurosurgery, Ebersh, Hospital Universitário Professor Alberto Antunes (UFAL), Maceió (AL), Brazil.
出版信息
Sao Paulo Med J. 2024 Jul 15;142(5):e2022591. doi: 10.1590/1516-3180.2022.0591.R1.20022024. eCollection 2024.
BACKGROUND
Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking.
OBJECTIVE
To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization.
DESIGN AND SETTING
This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil.
METHODS
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths).
RESULTS
Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients.
CONCLUSION
Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.
背景
栓塞术是治疗脑动静脉畸形（AVM）的一种很有前景的治疗策略。然而，对于AVM栓塞术的主要并发症或长期预后仍缺乏共识。
目的
描述接受治疗性栓塞的AVM患者中最常见的并发症和长期预后。
设计与地点
本系统评价在巴西阿拉戈斯联邦大学阿拉皮拉卡分校进行。
方法
本系统评价按照系统评价和Meta分析的首选报告项目标准进行。数据来自MEDLINE、PubMed、LILACS和SciELO数据库，包括人群的流行病学概况、所提议治疗的特征、并发症（出血事件和神经功能缺损）以及长期预后（治疗前后的改良Rankin量表、AVM再通、完全闭塞和死亡）。
结果
总体而言，分析纳入了34篇文章（2799例患者）。34.2%的病例观察到Ⅲ级Spetzler-Martin AVM。值得注意的是，39.3%的患者接受了栓塞术联合放射外科治疗。最常报告的长期并发症是出血，在平均随访58.6个月时，8.7%的患者发生出血。此外，平均34.7个月后，6.3%的患者出现神经功能缺损。平均36个月后，51.4%的病例实现了完全闭塞。3.5%的患者观察到AVM再通。4.0%的患者发生长期死亡。
结论
AVM栓塞术是一种越来越安全的策略，长期并发症发生率低，预后良好，尤其是在接受联合治疗的患者中。
系统评价注册
https://www.crd.york.ac.uk/prospero/ 注册号CRD42020204867。
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