脳動静脈奇形に対する姑息的塞栓術の長期予後：前向き登録多施設共同研究における傾向スコアマッチング解析
Tengfei Yu1, Lelin Zhang2, Heze Han1
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Background:
Brain arteriovenous malformations (BAVMs) have been found to be responsible for 25% of hemorrhage event in young patients. Palliative embolization (PE) has been increasingly used as the initial treatment because of its relatively simple operation and the previously reported acceptable risk of complications. The objective of this research was to reveal the long-term outcomes of death or hemorrhage events in BAVMs patients with either PE or conservative treatment.
Methods:
Study participants were recruited from a prospective, multicenter, collaborative registry research conducted from August 2011 to December 2021. Propensity score matching (PSM) followed by survival analyses were performed both overall and within strata defined by BAVM presentation (unruptured vs. ruptured) to compare long-term outcomes of death or hemorrhage event,as well as functional outcome. Additionally,the effectiveness of embolization extent and treatment strategies was assessed. Hazard ratios and 95% confidence intervals were analyzed with Cox proportional hazards models.
Results:
Of the 4, 286 consecutive BAVM patients,1, 072 received either conservative treatment or PE as initial treatment. After PSM,778 patients (389 matched pairs) comprised the overall cohort. PE was associated with a higher probability of long-term death or hemorrhage event compared with conservative treatment (4. 37vs. 1. 91 per 100 patient-years; HR:2. 30,95%CI:1. 37-3. 84). Subgroup analyses following separate PSM revealed consistent inferiority of PE in unruptured AVMs (188 pairs; 2. 77vs. 1. 07 per 100 patient-years; HR:2. 58, 95%CI:1. 13-5. 88). Conversely,PE demonstrated comparable outcomes to conservative treatment in ruptured AVMs (134 pairs; 5. 06vs. 2. 92 per 100 patient-years; HR:1. 54, 95%CI:0. 65-3. 68). The stratified comparison indicated potential benefit of majority embolization (defined as≥50% nidal reduction),with no death or hemorrhage events observed in either unruptured or ruptured BAVMs undergoing this approach. Long-term neurological status did not differ significantly between PE and conservative treatment strategies.
Conclusions:
PE was inferior to conservative treatment in preventing long-term death or hemorrhagic event in BAVMs,particularly among unruptured lesions. However,PE achieving ≥50% nidal reduction appeared beneficial.
