目的:确定脑动静脉畸形(rBAVM)破裂患者是否会从早期栓塞中获益。
方法:rBAVM首先在2002年3月至2022年5月之间通过栓塞治疗。当在出血后10天内进行时,早期定义为栓塞(第1组)。如果以后,栓塞被认为是晚期(第2组)。比较两组人口统计学和rBAVM数据。检索了高危出血成分和推迟栓塞的原因。主要终点为再出血。次要终点是良好的功能结果(FO,改良Rankin量表mRS≤2)和血管造影闭塞。通过多变量分析确定再出血和FO的预测因子。
结果:招募了105名患者(第1组N=34;第2组N=71)。之前没有发现再出血,在早期栓塞组的第一次栓塞期间或之后。晚期栓塞取决于漏诊和转诊方式。11名患者(10.5%)出现了再出血,其中在栓塞前N=3(仅在第2组中),N=5周栓塞(第1组第二次栓塞时N=2),栓塞后30天以上自发N=3。第1组栓塞了更多的高危成分(19/34;55.9vs17/71;23.9%;p=.011)。再出血率,末次FU的FO(90.9%vs74.3%)和闭塞率(80.8%vs88.5%)在组间没有差异。格拉斯哥昏迷评分≤8预测再出血,再出血与FO不良相关。
结论:早期栓塞确实可以预防再出血。总体再出血风险与晚期栓塞前出血和第二次栓塞时出血有关。再出血预测了最终的FO。
OBJECTIVE: To determine whether patients with a ruptured brain arteriovenous malformation (rBAVM) would benefit from an early embolization.
METHODS: rBAVM treated first by embolization between March 2002 and May 2022 were included. Embolization was defined early (Group 1) when performed within 10 days postbleeding. If later, embolization was considered late (Group 2). Demographic and rBAVM data were compared between the groups. High-risk bleeding components and reasons for deferring embolization were retrieved. Primary endpoint was rebleeding. Secondary endpoints were good functional outcome (FO, modified Rankin Scale mRS ≤ 2) and angiographic occlusion. Predictors of rebleeding and FO were determined by multivariate analysis.
RESULTS: 105 patients were recruited (N = 34 in Group 1; N = 71 in Group 2). No rebleeding was noted before, during or after the first embolization session in the early embolization group. Late embolization depended on missed diagnosis and referral pattern. Eleven patients (10.5%) suffered a rebleeding, of whom N = 3 before embolization (only in Group 2), N = 5 periembolization (N = 2 at the second embolization session in Group 1) and N = 3 spontaneous more than 30 days postembolization. More high-risk components were embolized in Group 1 (19/34; 55.9 vs 17/71; 23.9%; p = .011). Rebleeding rates, FO at last FU (90.9% vs 74.3%) and occlusion rates (80.8% vs 88.5%) did not differ between the groups. Glasgow coma scale ≤ 8 predicted rebleeding, rebleeding correlated with poor FO.
CONCLUSIONS: Early embolization did prevent rebleeding. The overall rebleeding risk was linked to bleeding before late embolization and bleeding at the second embolization. Rebleeding predicted the final FO.