来自未破裂的大脑动脉静脉瘤的未来出血风险:多中心动脉静脉瘤研究研究 (MARS)
Helen Kim1,2, Jeffrey Nelson1, Charles E McCulloch2
1Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco.
JAMA neurology
|October 6, 2025
概括
由于未破裂的大脑动脉静脉形 (AVM) 的每年内出血 (ICH) 风险低于此前所认为的. ICH的主要风险因素包括年龄,相关动脉瘤和深部AVM位置.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 流行病学 流行病学
背景情况:
- 由于未破裂的大脑动脉静脉形 (AVM) 的第一次内出血 (ICH) 的年率通常是2%至4%.
- 在未破裂的大脑AVM中缺乏ICH的精确估计和危险因素,阻碍了知情的治疗决策.
研究的目的:
- 为了估计率,并确定第一个ICH的风险因素,在一个大队伍的未破裂的大脑AVMs的个人.
主要方法:
- 多中心动脉静脉形研究研究 (MARS) 分析了2017-2023年9个国际队列 (2个基于人口,7个基于转诊) 的数据.
- 包括3030名没有破裂的大脑AVM的参与者;主要结果是时间到第一个ICH.
- 利用考克斯回归分析,对缺失的数据进行归算,在治疗,死亡或最后一次访问时进行审查.
主要成果:
- 年度ICH率为每100人年1.40 (95%CI,1.20-1.64),低于通常引用的数字.
- 显著的ICH独立风险因素包括诊断时年龄的增加 (P=.008),相关动脉瘤的存在 (P=.03) 和深部AVM位置 (P=.01).
- 45%的参与者出现了发作;AVM的中位直径为3.1厘米.
结论:
- 没有破裂的大脑AVM的实际年度ICH率低于临床实践估计.
- 老年,相关动脉瘤和深深的AVM位置是首次ICH的重要风险因素.
- 研究结果可以为患者咨询提供关于未被破坏的大脑AVM的自然史的信息.
相关概念视频
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...