Risk of endovascular treatment of brain arteriovenous malformations
Risk of endovascular treatment of brain arteriovenous malformations
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DOI：
10.1161/01.str.0000020123.80940.b2
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发表时间：
2002-07-01
期刊：
影响因子：
8.3
通讯作者：
Mast, H
中科院分区：
文献类型：
--
作者：
Hartmann, A;Pile-Spellman, J;Mast, H
背景和目的——关于脑动静脉畸形 (AVM) 血管内治疗后神经功能缺损的频率、严重程度和决定因素的独立评估数据很少。 方法——来自前瞻性哥伦比亚 AVM 研究项目，对 233 名接受 I 血管内治疗的连续脑 AVM 患者进行了分析。在完成血管内治疗之前和之后，神经科医生使用兰金量表评估神经损伤。多变量逻辑回归模型用于识别治疗相关神经功能缺损的人口统计学、临床和形态学预测因子。分析包括 AVM 手术 Spetzler-Martin 风险评分中使用的组成部分（AVM 大小、静脉引流模式和 AVM 位置）。 结果 - 233 名患者接受了 545 例血管内手术。平均随访时间为 9.6 个月（SD，18.1 个月）。 200 名患者（86%）在治疗后神经状态没有变化，33 名患者（14%）出现与治疗相关的神经功能缺损。后者中，5 人 (2%) 存在持续性失能缺陷（Rankin 评分 >2），2 人 (1%) 死亡。患者年龄增加[比值比 (OR), 1.04； 95% 置信区间 (CI)，1.01 至 1.08]、栓塞数量（OR，1.41；95% CI，1.16 至 1.70）以及治疗前无神经功能缺损（OR，4.55；95% CL 1.03 至 20.0）与新的神经功能缺损相关。所测试的所有形态学 AVM 特征都无法预测治疗并发症。结论 - 根据独立的神经学评估和前瞻性数据收集，我们的研究结果表明该中心血管内脑 AVM 治疗的致残治疗并发症发生率较低。血管内治疗的风险预测因素与动静脉畸形手术的风险预测因素不同。
Background and Purpose-Independently assessed data on frequency, severity, and determinants of neurological deficits after endovascular treatment of brain arteriovenous malformations (AVMs) are scarce.Methods-From the prospective Columbia AVM Study Project, 233 consecutive patients with brain AVM receiving I endovascular treatments were analyzed. Neurological impairment was assessed by a neurologist using the Rankin Scale before and after completed endovascular therapy. Multivariate logistic regression models were used to identify demographic, clinical, and morphological predictors of treatment-related neurological deficits. The analysis included the components used in the Spetzler-Martin risk score for AVM surgery (AVM size, venous drainage pattern, and eloquence of AVM location).Results-The 233 patients were treated with 545 endovascular procedures. Mean follow-up time was 9.6 months (SD, 18.1 months). Two hundred patients (86%) experienced no change in neurological status after treatment, and 33 patients (14%) showed treatment-related neurological deficits. Of the latter, 5 (2%) had persistent disabling deficits (Rankin score >2), and 2 (1%) died. Increasing patient age [odds ratio (OR), 1.04; 95% confidence interval (CI), 1.01 to 1.08], number of embolizations (OR, 1.41; 95% Cl, 1.16 to 1.70), and absence of a pretreatment neurological deficit (OR, 4.55; 95% CL 1.03 to 20.0) were associated with new neurological deficits. None of the morphological AVM characteristics tested predicted treatment complications.Conclusions-From independent neurological assessment and prospective data collection, our findings suggest a low rate of disabling treatment complications in this center for endovascular brain AVM treatment. Risk predictors for endovascular treatment differ from those for AVM surgery.