Comparison of conservative management, microsurgery only, and microsurgery with preoperative embolization for unruptured arteriovenous malformations: A propensity score weighted prospective cohort study

被引：1

作者：

Han, Heze ^{[1
,2
]}

Chen, Yu ^{[1
,2
]}

Ma, Li ^{[1
,2
]}

Li, Ruinan ^{[1
,2
]}

Li, Zhipeng ^{[1
,2
]}

Zhang, Haibin ^{[1
,2
]}

Yuan, Kexin ^{[1
,2
]}

Wang, Ke ^{[1
,2
]}

Jin, Hengwei ^{[3
]}

Meng, Xiangyu ^{[4
]}

Yan, Debin ^{[5
]}

Zhao, Yang ^{[6
]}

Zhang, Yukun ^{[6
]}

Jin, Weitao ^{[6
]}

Li, Runting ^{[1
,2
]}

Lin, Fa ^{[1
,2
]}

Hao, Qiang ^{[1
,2
]}

Wang, Hao ^{[1
,2
]}

Ye, Xun ^{[1
,2
]}

Kang, Shuai ^{[1
,2
]}

Gao, Dezhi ^{[7
]}

Sun, Shibin ^{[7
]}

Liu, Ali ^{[7
]}

Li, Youxiang ^{[3
]}

Chen, Xiaolin ^{[1
,2
,8
]}

Zhao, Yuanli ^{[1
,2
]}

Wang, Shuo ^{[1
,2
,8
]}

机构：

[1] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China

[2] China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China

[3] Capital Med Univ, Beijing Tiantan Hosp, Dept Intervent Neuroradiol, Beijing, Peoples R China

[4] Hebei Med Univ, Hebei Med Univ, Hosp 1, Dept Neurosurg, Shijiazhuang, Peoples R China

[5] Shanxi Prov Peoples Hosp, Dept Neurosurg, Taiyuan, Shanxi, Peoples R China

[6] Peking Univ, Peking Univ Int Hosp, Dept Neurosurg, Beijing, Peoples R China

[7] Capital Med Univ, Beijing Tiantan Hosp, Knife Ctr, Dept Gamma, Beijing, Peoples R China

[8] Capital Med Univ, Beijing Tiantan Hosp, China Natl Clin Res Ctr Neurol Dis, Beijing 100070, Peoples R China

来源：

CNS NEUROSCIENCE & THERAPEUTICS | 2024年 / 30卷 / 04期

基金：

中国国家自然科学基金;

关键词：

arteriovenous malformation; embolization; hemorrhagic stroke; microsurgery; neurologic deficit; INTERVENTIONAL THERAPY; MEDICAL-MANAGEMENT; RANDOMIZED-TRIAL; BRAIN; MULTICENTER; STATEMENT; OUTCOMES; SURGERY; ARUBA;

D O I：

10.1111/cns.14533

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

AimsTo compare the efficacy and deficiency of conservative management (CM), microsurgery (MS) only, and microsurgery with preoperative embolization (E + MS) for unruptured arteriovenous malformations (AVMs).MethodsWe prospectively included unruptured AVMs undergoing CM, MS, and E + MS from our institution between August 2011 and August 2021. The primary outcomes were long-term neurofunctional outcomes and hemorrhagic stroke and death. In addition to the comparisons among CM, MS, and E + MS, E + MS was divided into single-staged hybrid and multi-staged E + MS for further analysis. Stabilized inverse probability of treatment weighting using propensity scores was applied to control for confounders by treatment indication across the three groups.ResultsOf 3758 consecutive AVMs admitted, 718 patients were included finally (266 CM, 364 MS, and 88 E + MS). The median follow-up duration was 5.4 years. Compared with CM, interventions (MS and E + MS) were associated with neurological deterioration. MS could lower the risk of hemorrhagic stroke and death. Multi-staged E + MS was associated with neurological deterioration and higher hemorrhagic risks compared with MS, but the hybrid E + MS operation significantly reduced the hemorrhage risk.ConclusionIn this study, unruptured AVMs receiving CM would expect better neurofunctional outcomes but bear higher risks of hemorrhage than MS or E + MS. The single-staged hybrid E + MS might be promising in reducing inter-procedural and subsequent hemorrhage. Microsurgery (MS) only and microsurgery with preoperative embolization (E + MS) could significantly prevent the hemorrhagic risk but caused more neurofunctional deficit than conservative management (CM).image

引用

页数：11

共 25 条

[21] Correspondence on 'Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study' by Musmar et al [J].

Shah, Keyur ;

Srinivas, Dwarakanath .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2024,

[22] Comparison of Pipeline Embolization Device and Flow Re-Direction Endoluminal Device Flow Diverters for Internal Carotid Artery Aneurysms: A Propensity Score-Matched Cohort Study [J].

Griessenauer, Christoph J. ;

Thomas, Ajith J. ;

Enriquez-Marulanda, Alejandro ;

Deshmukh, Aviraj ;

Jain, Abhi ;

Ogilvy, Christopher S. ;

Kocer, Naci ;

Engelhorn, Tobias ;

Moehlenbruch, Markus ;

Holtmannspotter, Markus ;

Janssen, Hendrik ;

Finkenzeller, Thomas ;

Reith, Wolfgang ;

Sonnberger, Michael ;

Buhk, Jan-Hendrik ;

Schirmer, Clemens M. ;

Killer-Oberpfalzer, Monika .

NEUROSURGERY, 2019, 85 (02) :E249-E255

[23] Pharmacy-Mediated Antiplatelet Management Protocol Compared to One-time Platelet Function Testing Prior to Pipeline Embolization of Cerebral Aneurysms: A Propensity Score-Matched Cohort Study [J].

Griessenauer, Christoph J. ;

Jain, Abhi ;

Enriquez-Marulanda, Alejandro ;

Gupta, Raghav ;

Adeeb, Nimer ;

Moore, Justin M. ;

Grassi, Stacey A. ;

Dalal, Shamsher S. ;

Ogilvy, Christopher S. ;

Thomas, Ajith J. ;

Schirmer, Clemens M. .

NEUROSURGERY, 2019, 84 (03) :673-679

[24] Differential clinical outcomes after 3 versus 5 years in a comparison of preoperative chemotherapy with and without radiotherapy in locally advanced rectal cancer: A national cohort propensity score-matched study [J].

Zhang, Yuanxin ;

Luo, Rui ;

Peng, Jingqi ;

He, Zichuan ;

Tan, Delin ;

Liu, Xueping ;

Wang, Hui ;

Wang, Huaiming .

HELIYON, 2024, 10 (06)

[25] Comparison of Early Surgical or Transcatheter Aortic Valve Replacement Versus Conservative Management in Low-Flow, Low-Gradient Aortic Stenosis Using Inverse Probability of Treatment Weighting: Results From the TOPAS Prospective Observational Cohort Study [J].

Annabi, Mohamed-Salah ;

Cote, Nancy ;

Dahou, Abdellaziz ;

Bartko, Philipp E. ;

Bergler-Klein, Jutta ;

Burwash, Ian G. ;

Orwat, Stefan ;

Baumgartner, Helmut ;

Mascherbauer, Julia ;

Mundigler, Gerald ;

Fukui, Miho ;

Cavalcante, Joao ;

Ribeiro, Henrique B. ;

Rodes-Cabau, Josep ;

Clavel, Marie-Annick ;

Pibarot, Philippe .

JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2020, 9 (24)

← 1 2 3 →