血管内栓塞术和立体定向放射外科作为破裂动静脉畸形一线治疗的长期结果：一项使用全国多中心前瞻性登记数据的倾向评分匹配分析

Long-term outcomes of endovascular embolization and stereotactic radiosurgery as the first-line treatment for ruptured arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.

作者信息

Chen Yu, Wang Chengzhuo, Han Heze, Ma Li, Li Ruinan, Li Zhipeng, Zhang Haibin, Yuan Kexin, Li Anqi, Zhu Qinghui, Su Yongenbo, Gao Dezhi, Jin Hengwei, Li Youxiang, Sun Shibin, Zhao Yuanli, Chen Xiaolin, Zhao Jizong

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Int J Surg. 2025 Aug 1;111(8):5182-5191. doi: 10.1097/JS9.0000000000002546. Epub 2025 May 28.

DOI:10.1097/JS9.0000000000002546

PMID:40434741

Abstract

BACKGROUND

This study aimed to evaluate and compare the risk-benefit profiles of endovascular embolization (EM) and stereotactic radiosurgery (SRS) as first-line therapeutic strategies for the management of ruptured arteriovenous malformations (AVMs).

MATERIALS AND METHODS

We included patients with ruptured AVMs who underwent EM or SRS as the first-line treatments from a nationwide prospective multicenter registry (the MATCH study) in China. Propensity score matching was employed to balance baseline characteristics between the EM and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, while secondary outcomes included long-term obliteration rates and neurological status. Subgroup analyses and sensitivity analyses using alternative study designs were conducted to ensure the robustness and consistency of the findings.

RESULT

Of 3909 consecutive AVMs in the registry from 2011.08 to 2021.12, 1067 patients were eligible. After matching, 640 AVMs remained for the final analysis. The mean follow-up duration was 5.27 years. In terms of primary outcomes, SRS was associated with a lower risk of hemorrhagic stroke or death (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23 to 0.58). Regarding the secondary outcomes, SRS was observed to have a significant advantage in long-term obliteration (odds ratio [OR] 7.89, 95% CI 5.15 to 12.11), and the incidence was significantly lower in the SRS group than in the EM group for the disabling neurological deficits (OR, 0.42, 95% CI, 0.25 to 0.70). Results of subgroup analyses and sensitivity analyses were consistent in the trend but with slightly varied powers.

CONCLUSION

This study suggests that SRS can be more effective than EM in preventing future hemorrhagic stroke or death, achieving complete obliteration, and reducing long-term neurological disability.

摘要

背景

本研究旨在评估和比较血管内栓塞术（EM）和立体定向放射外科治疗（SRS）作为破裂动静脉畸形（AVM）一线治疗策略的风险效益概况。

材料与方法

我们纳入了来自中国一项全国性前瞻性多中心注册研究（MATCH研究）中接受EM或SRS作为一线治疗的破裂AVM患者。采用倾向评分匹配法平衡EM组和SRS组之间的基线特征。主要结局为长期出血性卒中或死亡，次要结局包括长期闭塞率和神经功能状态。进行亚组分析和采用替代研究设计的敏感性分析，以确保研究结果的稳健性和一致性。

结果

在2011年8月至2021年12月登记的3909例连续性AVM中，1067例患者符合条件。匹配后，640例AVM用于最终分析。平均随访时间为5.27年。在主要结局方面，SRS与出血性卒中或死亡风险较低相关（风险比[HR]0.36，95%置信区间[CI]0.23至0.58）。关于次要结局，观察到SRS在长期闭塞方面具有显著优势（优势比[OR]7.89，95%CI5.15至12.11），并且SRS组中致残性神经功能缺损的发生率显著低于EM组（OR，0.42，95%CI，0.25至0.70）。亚组分析和敏感性分析的结果在趋势上一致，但效力略有不同。