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以治愈为目的的颅内动静脉畸形栓塞术后血管造影闭塞的预测因素。

Predictors of angiographic occlusion after embolization of intracranial arteriovenous malformations with curative intent.

作者信息

Roy Joanna M, Musmar Basel, Majmundar Shyam, Kaul Anand, Atallah Elias, Zanaty Mario, Sizdahkhani Saman, Mouchtouris Nikolaos, Mastorakos Panagiotis, Tjoumakaris Stavropoula I, Gooch Michael R, Rosenwasser Robert H, Jabbour Pascal M

机构信息

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

出版信息

Interv Neuroradiol. 2025 Apr 15:15910199251332400. doi: 10.1177/15910199251332400.

Abstract

BackgroundEndovascular embolization is a potential alternative to open surgery for treating intracranial arteriovenous malformations (AVMs). To our knowledge, predictors of occlusion after curative embolization of AVMs remain limited in literature. Our study aims to identify predictors of radiographic occlusion after embolization of AVMs with curative intent.MethodsThis was a retrospective study of patients who underwent embolization of AVMs with curative intent at a single institution between 2007 and 2022. The primary outcome of cure was defined as radiographic occlusion of the AVM on follow-up. Univariate and multivariate analyses were performed with a value <0.05 denoting statistical significance.ResultsSixty-six patients underwent embolization of an AVM with curative intent. The median (interquartile range (IQR)) age of the cohort was 53 (36-62), and 48.5% were male. 65.2% ( = 43) patients presented with hemorrhage. 59.1% ( = 39) of the cohort achieved cure on follow-up. Median (IQR) volume of AVM (mm and maximum pedicle size (mm) were significantly higher in patients who were not cured on follow-up compared to those who were cured: 14055.12 (2431.71-31235.60) and 1.9 (1.3-2.5) versus 3888 (2063-12518) and 1.3 (1.1-1.6), respectively. On multivariate regression, maximum pedicle size was associated with lower odds of cure (OR: 0.24, 95% CI: 0.07-0.82, = 0.023).ConclusionsOur study identified maximum pedicle size to be the only significant factor associated with lower odds of radiographic occlusion after curative embolization of AVMs. Further multicenter studies are required to validate these findings.

摘要

背景

血管内栓塞术是治疗颅内动静脉畸形(AVM)的一种潜在替代开放性手术的方法。据我们所知,关于AVM根治性栓塞术后闭塞的预测因素在文献中仍然有限。我们的研究旨在确定有治愈意图的AVM栓塞术后影像学闭塞的预测因素。

方法

这是一项对2007年至2022年期间在单一机构接受有治愈意图的AVM栓塞术的患者进行的回顾性研究。治愈的主要结局定义为随访时AVM的影像学闭塞。进行单因素和多因素分析,P值<0.05表示具有统计学意义。

结果

66例患者接受了有治愈意图的AVM栓塞术。该队列的中位(四分位间距(IQR))年龄为53岁(36 - 62岁),48.5%为男性。65.2%(n = 43)的患者出现出血。59.1%(n = 39)的队列在随访时实现了治愈。与治愈的患者相比,随访未治愈的患者中,AVM的中位(IQR)体积(mm³)和最大蒂尺寸(mm)显著更高:分别为14055.12(2431.71 - 31235.60)和1.9(1.3 - 2.5),而治愈患者分别为3888(2063 - 12518)和1.3(1.1 - 1.6)。在多因素回归分析中,最大蒂尺寸与治愈几率较低相关(OR:0.24,95%CI:0.07 - 0.82,P = 0.023)。

结论

我们的研究确定最大蒂尺寸是与AVM根治性栓塞术后影像学闭塞几率较低相关的唯一重要因素。需要进一步的多中心研究来验证这些发现。

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本文引用的文献

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Clinical outcome following cerebral AVM hemorrhage.脑动静脉畸形出血后的临床转归。
Acta Neurochir (Wien). 2020 Jul;162(7):1759-1766. doi: 10.1007/s00701-020-04380-z. Epub 2020 May 8.

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