Juan E Basilio Flores, Joel Aguilar-Melgar, Henry Pacheco-Fernandez Baca
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引用次数: 0
Abstract
Background: Endovascular embolization is an accepted treatment modality for brain arteriovenous malformations (bAVM); however, treatment outcomes are highly variable, warranting accurate prediction for adequate patient selection. Several predictive scores have been proposed for this purpose. The objective of this study was to externally validate these scores for embolization of bAVM.
Methods: This study involved bAVM patients treated with transarterial embolization. Endovascular predictive scores were identified through literature search. Relevant data for scoring of included patients was extracted. Primary study outcomes were radiological cure and neurological complications. The performance of the scores was evaluated by analyzing calibration (z-scores from logistic regression), discrimination (area under the receiver operating characteristic curve, AUROC), and classification (Youden's index and corresponding sensitivity and specificity). Additionally, sensitivity analyses were performed restricting the study population by size, location, and embolization intent.
Results: A total of 198 bAVM (190 patients) were included. The rates of radiological cure and neurological complications were 18.2% and 14.1%, respectively. The literature search identified seven predictive scores. In the overall analysis, the Toronto score showed the best performance for radiological cure (AUROC 0.905). No significant difference was observed between the performance of the assessed scores for neurological complications. The sensitivity analysis showed improved performance of most scores. The Toronto score exhibited the highest performance for radiological cure (AUROC 0.857). The AVM Embolization Prognostic Risk Score (AVMEPRS) showed the highest performance for neurological complications (AUROC 0.751). The AVM Embocure Score (AVMES) showed fair to good performance for both efficacy and safety outcomes.
Conclusion: Among the selected scores, the Toronto, AVMEPRS, and AVMES scores showed the best performances.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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