International journal of surgery (London, England) · 2025
Long-term outcomes of endovascular embolization and stereotactic radiosurgery as the first-line treatment for ruptured arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Chen Yu, Wang Chengzhuo, Han Heze, Ma Li, Li Ruinan, Li Zhipeng, Zhang Haibin, Yuan Kexin, Li Anqi, Zhu Qinghui, Su Yongenbo, Gao Dezhi, Jin Hengwei, Li Youxiang, Sun Shibin, Zhao Yuanli, Chen Xiaolin, Zhao Jizong, Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)
Аннотация
BACKGROUND: This study aimed to evaluate and compare the risk-benefit profiles of endovascular embolization (EM) and stereotactic radiosurgery (SRS) as first-line therapeutic strategies for the management of ruptured arteriovenous malformations (AVMs).
MATERIALS AND METHODS: We included patients with ruptured AVMs who underwent EM or SRS as the first-line treatments from a nationwide prospective multicenter registry (the MATCH study) in China. Propensity score matching was employed to balance baseline characteristics between the EM and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, while secondary outcomes included long-term obliteration rates and neurological status. Subgroup analyses and sensitivity analyses using alternative study designs were conducted to ensure the robustness and consistency of the findings.
RESULT: Of 3909 consecutive AVMs in the registry from 2011.08 to 2021.12, 1067 patients were eligible. After matching, 640 AVMs remained for the final analysis. The mean follow-up duration was 5.27 years. In terms of primary outcomes, SRS was associated with a lower risk of hemorrhagic stroke or death (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23 to 0.58). Regarding the secondary outcomes, SRS was observed to have a significant advantage in long-term obliteration (odds ratio [OR] 7.89, 95% CI 5.15 to 12.11), and the incidence was significantly lower in the SRS group than in the EM group for the disabling neurological deficits (OR, 0.42, 95% CI, 0.25 to 0.70). Results of subgroup analyses and sensitivity analyses were consistent in the trend but with slightly varied powers.
CONCLUSION: This study suggests that SRS can be more effective than EM in preventing future hemorrhagic stroke or death, achieving complete obliteration, and reducing long-term neurological disability.
MATERIALS AND METHODS: We included patients with ruptured AVMs who underwent EM or SRS as the first-line treatments from a nationwide prospective multicenter registry (the MATCH study) in China. Propensity score matching was employed to balance baseline characteristics between the EM and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, while secondary outcomes included long-term obliteration rates and neurological status. Subgroup analyses and sensitivity analyses using alternative study designs were conducted to ensure the robustness and consistency of the findings.
RESULT: Of 3909 consecutive AVMs in the registry from 2011.08 to 2021.12, 1067 patients were eligible. After matching, 640 AVMs remained for the final analysis. The mean follow-up duration was 5.27 years. In terms of primary outcomes, SRS was associated with a lower risk of hemorrhagic stroke or death (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23 to 0.58). Regarding the secondary outcomes, SRS was observed to have a significant advantage in long-term obliteration (odds ratio [OR] 7.89, 95% CI 5.15 to 12.11), and the incidence was significantly lower in the SRS group than in the EM group for the disabling neurological deficits (OR, 0.42, 95% CI, 0.25 to 0.70). Results of subgroup analyses and sensitivity analyses were consistent in the trend but with slightly varied powers.
CONCLUSION: This study suggests that SRS can be more effective than EM in preventing future hemorrhagic stroke or death, achieving complete obliteration, and reducing long-term neurological disability.