Comparison of conservative management, microsurgery only, and microsurgery with preoperative embolization for unruptured arteriovenous malformations: A propensity score weighted prospective cohort study.

Autor:	Han, Heze, Chen, Yu, Ma, Li, Li, Ruinan, Li, Zhipeng, Zhang, Haibin, Yuan, Kexin, Wang, Ke, Jin, Hengwei, Meng, Xiangyu, Yan, Debin, Zhao, Yang, Zhang, Yukun, Jin, Weitao, Li, Runting, Lin, Fa, Hao, Qiang, Wang, Hao, Ye, Xun, Kang, Shuai
Předmět:	ARTERIOVENOUS malformation HEMORRHAGIC stroke MICROSURGERY THERAPEUTIC embolization CLINICAL deterioration COHORT analysis LONGITUDINAL method
Zdroj:	CNS Neuroscience & Therapeutics; Apr2024, Vol. 30 Issue 4, p1-11, 11p
Abstrakt:	Aims: To compare the efficacy and deficiency of conservative management (CM), microsurgery (MS) only, and microsurgery with preoperative embolization (E + MS) for unruptured arteriovenous malformations (AVMs). Methods: We prospectively included unruptured AVMs undergoing CM, MS, and E + MS from our institution between August 2011 and August 2021. The primary outcomes were long‐term neurofunctional outcomes and hemorrhagic stroke and death. In addition to the comparisons among CM, MS, and E + MS, E + MS was divided into single‐staged hybrid and multi‐staged E + MS for further analysis. Stabilized inverse probability of treatment weighting using propensity scores was applied to control for confounders by treatment indication across the three groups. Results: Of 3758 consecutive AVMs admitted, 718 patients were included finally (266 CM, 364 MS, and 88 E + MS). The median follow‐up duration was 5.4 years. Compared with CM, interventions (MS and E + MS) were associated with neurological deterioration. MS could lower the risk of hemorrhagic stroke and death. Multi‐staged E + MS was associated with neurological deterioration and higher hemorrhagic risks compared with MS, but the hybrid E + MS operation significantly reduced the hemorrhage risk. Conclusion: In this study, unruptured AVMs receiving CM would expect better neurofunctional outcomes but bear higher risks of hemorrhage than MS or E + MS. The single‐staged hybrid E + MS might be promising in reducing inter‐procedural and subsequent hemorrhage. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
Externí odkaz:	Zobrazit plný text záznamu Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.