Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

Yu Chen; Heze Han; Hengwei Jin; Xiangyu Meng; Li Ma; Ruinan Li; Zhipeng Li; Debin Yan; Haibin Zhang; Kexin Yuan; Ke Wang; Yang Zhao; Yukun Zhang; Weitao Jin; Runting Li; Fa Lin; Qiang Hao; Hao Wang; Xun Ye; Shuai Kang; Dezhi Gao; Jun Pu; Zhiyong Shi; Xiaofeng Chao; Zhengfeng Lin; Junlin Lu; Jiangan Li; Shibin Sun; Ali Liu; Xiaolin Chen; Youxiang Li; Yuanli Zhao; Shuo Wang; Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)

doi:10.1097/JS9.0000000000000341

Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data

Int J Surg. 2023 Jul 1;109(7):1900-1909. doi: 10.1097/JS9.0000000000000341.

Authors

Yu Chen^{1

2}, Heze Han^{1

2}, Hengwei Jin³, Xiangyu Meng⁴, Li Ma^{1

2}, Ruinan Li^{1

2}, Zhipeng Li^{1

2}, Debin Yan⁵, Haibin Zhang^{1

2}, Kexin Yuan^{1

2}, Ke Wang^{1

2}, Yang Zhao⁶, Yukun Zhang⁶, Weitao Jin⁶, Runting Li^{1

2}, Fa Lin^{1

2}, Qiang Hao^{1

2}, Hao Wang^{1

2}, Xun Ye^{1

2}, Shuai Kang^{1

2}, Dezhi Gao⁷, Jun Pu⁸, Zhiyong Shi⁹, Xiaofeng Chao¹⁰, Zhengfeng Lin¹¹, Junlin Lu¹², Jiangan Li¹³, Shibin Sun⁷, Ali Liu⁵, Xiaolin Chen^{1

2}, Youxiang Li³, Yuanli Zhao^{1

2}, Shuo Wang^{1

2}; Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)

Affiliations

¹ Department of Neurosurgery.
² China National Clinical Research Center for Neurological Diseases.
³ Department of Interventional Neuroradiology.
⁴ Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang.
⁵ Department of Neurosurgery, Shanxi Provincial People's Hospital, Shanxi.
⁶ Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing.
⁷ Department of Gamma-Knife center, Beijing Tiantan Hospital, Capital Medical University.
⁸ First Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
⁹ Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University, Nanjing.
¹⁰ Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Jiangsu.
¹¹ Department of Neurosurgery, The First People's Hospital of Qinzhou, Guangxi.
¹² Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan.
¹³ Department of Neurosurgery, The Affiliated Wuxi NO.2 People's Hospital of Jiangnan University, Wuxi.

Abstract

Background: Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outcome of hemorrhagic stroke or death in patients with either conservative management or stand-alone embolization for AVM.

Methods: The study population was derived from a nationwide multicenter prospective collaboration registry (the MATCH registry) between August 2011 and August 2021. The propensity score-matched survival analysis was performed in the overall and stratified AVM cases (unruptured and ruptured), respectively, to compare the long-term outcome of hemorrhagic stroke or death, and neurological status. The efficacy of distinct embolization strategies was also evaluated. Hazard ratios (HRs) with 95% CI were calculated using Fine-Gray competing risk models.

Results: Of the 3682 consecutive AVMs, 906 underwent either conservative management or embolization as the stand-alone management strategy. After propensity score matching, a total of 622 (311 pairs) patients constituted an overall cohort. The unruptured and ruptured subgroups were composed of 288 cases (144 pairs) and 252 cases (126 pairs), respectively. In the overall cohort, embolization did not prevent long-term hemorrhagic stroke or death compared with conservative management [2.07 vs. 1.57 per 100 patient-years; HR, 1.28 (95% CI, 0.81-2.04)]. Similar results were maintained in both unruptured AVMs [1.97 vs. 0.93 per 100 patient-years; HR, 2.09 (95% CI, 0.99-4.41)] and ruptured AVMs [2.36 vs. 2.57 per 100 patient-years; HR, 0.76 (95% CI, 0.39-1.48)]. Stratified analysis showed that the target embolization might be beneficial for unruptured AVMs [HR, 0.42 (95% CI, 0.08-2.29)], while the curative embolization improved the outcome of ruptured AVMs [HR, 0.29 (95% CI, 0.10-0.87)]. The long-term neurological status was similar between these two strategies.

Conclusions: This prospective cohort study did not support a substantial superiority of embolization over conservative management for AVMs in preventing long-term hemorrhagic stroke or death.

Trial registration: ClinicalTrials.gov NCT04572568.

Publication types

Multicenter Study

MeSH terms

Brain
Embolization, Therapeutic* / adverse effects
Embolization, Therapeutic* / methods
Hemorrhagic Stroke* / complications
Hemorrhagic Stroke* / therapy
Humans
Intracranial Arteriovenous Malformations* / complications
Intracranial Arteriovenous Malformations* / surgery
Propensity Score
Prospective Studies
Radiosurgery* / methods
Retrospective Studies
Routinely Collected Health Data
Rupture
Treatment Outcome
Young Adult

Associated data

ClinicalTrials.gov/NCT04572568