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Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data
Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outc...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389468/ https://www.ncbi.nlm.nih.gov/pubmed/37226884 http://dx.doi.org/10.1097/JS9.0000000000000341 |
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author | Chen, Yu Han, Heze Jin, Hengwei Meng, Xiangyu Ma, Li Li, Ruinan Li, Zhipeng Yan, Debin Zhang, Haibin Yuan, Kexin Wang, Ke Zhao, Yang Zhang, Yukun Jin, Weitao Li, Runting Lin, Fa Hao, Qiang Wang, Hao Ye, Xun Kang, Shuai Gao, Dezhi Pu, Jun Shi, Zhiyong Chao, Xiaofeng Lin, Zhengfeng Lu, Junlin Li, Jiangan Sun, Shibin Liu, Ali Chen, Xiaolin Li, Youxiang Zhao, Yuanli Wang, Shuo |
author_facet | Chen, Yu Han, Heze Jin, Hengwei Meng, Xiangyu Ma, Li Li, Ruinan Li, Zhipeng Yan, Debin Zhang, Haibin Yuan, Kexin Wang, Ke Zhao, Yang Zhang, Yukun Jin, Weitao Li, Runting Lin, Fa Hao, Qiang Wang, Hao Ye, Xun Kang, Shuai Gao, Dezhi Pu, Jun Shi, Zhiyong Chao, Xiaofeng Lin, Zhengfeng Lu, Junlin Li, Jiangan Sun, Shibin Liu, Ali Chen, Xiaolin Li, Youxiang Zhao, Yuanli Wang, Shuo |
author_sort | Chen, Yu |
collection | PubMed |
description | Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outcome of hemorrhagic stroke or death in patients with either conservative management or stand-alone embolization for AVM. METHODS: The study population was derived from a nationwide multicenter prospective collaboration registry (the MATCH registry) between August 2011 and August 2021. The propensity score-matched survival analysis was performed in the overall and stratified AVM cases (unruptured and ruptured), respectively, to compare the long-term outcome of hemorrhagic stroke or death, and neurological status. The efficacy of distinct embolization strategies was also evaluated. Hazard ratios (HRs) with 95% CI were calculated using Fine-Gray competing risk models. RESULTS: Of the 3682 consecutive AVMs, 906 underwent either conservative management or embolization as the stand-alone management strategy. After propensity score matching, a total of 622 (311 pairs) patients constituted an overall cohort. The unruptured and ruptured subgroups were composed of 288 cases (144 pairs) and 252 cases (126 pairs), respectively. In the overall cohort, embolization did not prevent long-term hemorrhagic stroke or death compared with conservative management [2.07 vs. 1.57 per 100 patient-years; HR, 1.28 (95% CI, 0.81–2.04)]. Similar results were maintained in both unruptured AVMs [1.97 vs. 0.93 per 100 patient-years; HR, 2.09 (95% CI, 0.99–4.41)] and ruptured AVMs [2.36 vs. 2.57 per 100 patient-years; HR, 0.76 (95% CI, 0.39–1.48)]. Stratified analysis showed that the target embolization might be beneficial for unruptured AVMs [HR, 0.42 (95% CI, 0.08–2.29)], while the curative embolization improved the outcome of ruptured AVMs [HR, 0.29 (95% CI, 0.10-0.87)]. The long-term neurological status was similar between these two strategies. CONCLUSIONS: This prospective cohort study did not support a substantial superiority of embolization over conservative management for AVMs in preventing long-term hemorrhagic stroke or death. |
format | Online Article Text |
id | pubmed-10389468 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-103894682023-08-01 Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data Chen, Yu Han, Heze Jin, Hengwei Meng, Xiangyu Ma, Li Li, Ruinan Li, Zhipeng Yan, Debin Zhang, Haibin Yuan, Kexin Wang, Ke Zhao, Yang Zhang, Yukun Jin, Weitao Li, Runting Lin, Fa Hao, Qiang Wang, Hao Ye, Xun Kang, Shuai Gao, Dezhi Pu, Jun Shi, Zhiyong Chao, Xiaofeng Lin, Zhengfeng Lu, Junlin Li, Jiangan Sun, Shibin Liu, Ali Chen, Xiaolin Li, Youxiang Zhao, Yuanli Wang, Shuo Int J Surg Original Research Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outcome of hemorrhagic stroke or death in patients with either conservative management or stand-alone embolization for AVM. METHODS: The study population was derived from a nationwide multicenter prospective collaboration registry (the MATCH registry) between August 2011 and August 2021. The propensity score-matched survival analysis was performed in the overall and stratified AVM cases (unruptured and ruptured), respectively, to compare the long-term outcome of hemorrhagic stroke or death, and neurological status. The efficacy of distinct embolization strategies was also evaluated. Hazard ratios (HRs) with 95% CI were calculated using Fine-Gray competing risk models. RESULTS: Of the 3682 consecutive AVMs, 906 underwent either conservative management or embolization as the stand-alone management strategy. After propensity score matching, a total of 622 (311 pairs) patients constituted an overall cohort. The unruptured and ruptured subgroups were composed of 288 cases (144 pairs) and 252 cases (126 pairs), respectively. In the overall cohort, embolization did not prevent long-term hemorrhagic stroke or death compared with conservative management [2.07 vs. 1.57 per 100 patient-years; HR, 1.28 (95% CI, 0.81–2.04)]. Similar results were maintained in both unruptured AVMs [1.97 vs. 0.93 per 100 patient-years; HR, 2.09 (95% CI, 0.99–4.41)] and ruptured AVMs [2.36 vs. 2.57 per 100 patient-years; HR, 0.76 (95% CI, 0.39–1.48)]. Stratified analysis showed that the target embolization might be beneficial for unruptured AVMs [HR, 0.42 (95% CI, 0.08–2.29)], while the curative embolization improved the outcome of ruptured AVMs [HR, 0.29 (95% CI, 0.10-0.87)]. The long-term neurological status was similar between these two strategies. CONCLUSIONS: This prospective cohort study did not support a substantial superiority of embolization over conservative management for AVMs in preventing long-term hemorrhagic stroke or death. Lippincott Williams & Wilkins 2023-05-24 /pmc/articles/PMC10389468/ /pubmed/37226884 http://dx.doi.org/10.1097/JS9.0000000000000341 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (https://creativecommons.org/licenses/by/4.0/) (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Original Research Chen, Yu Han, Heze Jin, Hengwei Meng, Xiangyu Ma, Li Li, Ruinan Li, Zhipeng Yan, Debin Zhang, Haibin Yuan, Kexin Wang, Ke Zhao, Yang Zhang, Yukun Jin, Weitao Li, Runting Lin, Fa Hao, Qiang Wang, Hao Ye, Xun Kang, Shuai Gao, Dezhi Pu, Jun Shi, Zhiyong Chao, Xiaofeng Lin, Zhengfeng Lu, Junlin Li, Jiangan Sun, Shibin Liu, Ali Chen, Xiaolin Li, Youxiang Zhao, Yuanli Wang, Shuo Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title | Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title_full | Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title_fullStr | Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title_full_unstemmed | Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title_short | Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
title_sort | association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389468/ https://www.ncbi.nlm.nih.gov/pubmed/37226884 http://dx.doi.org/10.1097/JS9.0000000000000341 |
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