Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study.
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Musmar Basel, Adeeb Nimer, Roy Joanna M, Abdalrazeq Hammam, Tjoumakaris Stavropoula I, Atallah Elias, Salim Hamza Adel, Kondziolka Douglas, Sheehan Jason, Ogilvy Christopher S, Riina Howard, Kandregula Sandeep, Dmytriw Adam A, El Naamani Kareem, Abdelsalam Ahmed, Ironside Natasha, Kumbhare Deepak, Ataoglu Cagdas, Essibayi Muhammed Amir, Keles Abdullah, Muram Sandeep, Sconzo Daniel, Rezai Arwin, Erginoglu Ufuk, Pöppe Johannes, Sen Rajeev D, Griessenauer Christoph J, Burkhardt Jan-Karl, Starke Robert M, Baskaya Mustafa K, Sekhar Laligam N, Levitt Michael R, Altschul David J, McAvoy Malia, Aslan Assala, Abushehab Abdallah, Swaid Christian, Abla Adib A, Gooch M Reid, Rosenwasser Robert H, Stapleton Christopher, Koch Matthew, Srinivasan Visish M, Chen Peng R, Blackburn Spiros, Dannenbaum Mark J, Choudhri Omar, Pukenas Bryan, Orbach Darren, Smith Edward, Mosimann Pascal J, Alaraj Ali, Aziz-Sultan Mohammad A, Patel Aman B, Cuellar Hugo H, Lawton Michael T, Morcos Jacques, Guthikonda Bharat, Jabbour Pascal
Аннотация
OBJECTIVE: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III.
METHODS: This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I-III between January 2010 and December 2023 were included.
RESULTS: The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group.
CONCLUSION: Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed.