Transarterial AVM embolization using Tsinghua grading system: Patient selection and complete obliteration

Huachen Zhang , Youle Su , Shikai Liang , Xianli Lv
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Abstract

Objective

Endovascular embolization has an important role in the management of brain arteriovenous malformations (AVMs). A Tsinghua AVM grading system has been proposed for patient selection and complete obliteration. The authors sought to validate this system in an independent patient cohort and compare it to the Buffalo grading system.

Methods

Consecutive 52 patients underwent endovascular AVM embolization between January 2019 and December 2021 according to Tsinghua AVM grading system. Each AVM was also graded using Buffalo grading system. Baseline clinical characteristics, complications, and AVM obliteration were compared between Tsinghua and Buffalo scales.

Results

Complete obliteration of AVM was obtained in 29 patients (55.8%). Three complications were encountered, one bleeding (1.9%) and 2 ischemic (3.8%), in 3(5.7%) patients who recovered completely at follow-up. The Tsinghua scale (p=0.017) was predictor of complete obliteration as well as Buffalo scale (p=0.002) on ROC curve analysis and their AUCs were not significantly different (p=0.672). The Tsinghua scale was also associated with the initial patient status (p=0.003) and injected Onyx volume (p=0.003) on linear regression test. Because of the low complication rate, neither the Tsinghua scale nor the Buffalo scale predicted complication risk related to AVM embolization.

Conclusions

The bleeding complication rate of 1.9% is within the range of rupture risk reported in the natural history of AVMs. In addition to predicting complete AVM obliteration as well as Buffalo scale, the Tsinghua scale can also predict the patients' status and the volume of Onyx avoid over injection.

Key messages

The Tsinghua grading system for endovascular AVM embolization will guide patient selection of AVM embolization.

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采用清华分级系统的经动脉 AVM 栓塞术:患者选择和完全阻塞
目的血管内栓塞术在脑动静脉畸形(AVM)的治疗中发挥着重要作用。目前已提出了一套清华脑动静脉畸形分级系统,用于患者的选择和完全栓塞。作者试图在一个独立的患者队列中验证这一系统,并将其与布法罗分级系统进行比较。方法2019年1月至2021年12月期间,连续52名患者根据清华AVM分级系统接受了血管内AVM栓塞术。每个 AVM 也使用水牛城分级系统进行分级。结果29例患者(55.8%)的AVM完全消失。有 3 例患者(5.7%)出现并发症,其中 1 例出血(1.9%),2 例缺血(3.8%),随访时完全康复。在 ROC 曲线分析中,清华量表(p=0.017)和水牛量表(p=0.002)均可预测完全血栓闭塞,两者的 AUC 无明显差异(p=0.672)。在线性回归测试中,清华量表还与患者初始状态(p=0.003)和注射奥硝唑量(p=0.003)相关。结论出血并发症发生率为 1.9%,在 AVM 自然史报告的破裂风险范围内。除了能像水牛城量表一样预测 AVM 的完全阻塞外,清华量表还能预测患者的状况和避免注射过量的 Onyx。
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来源期刊
Neuroscience informatics
Neuroscience informatics Surgery, Radiology and Imaging, Information Systems, Neurology, Artificial Intelligence, Computer Science Applications, Signal Processing, Critical Care and Intensive Care Medicine, Health Informatics, Clinical Neurology, Pathology and Medical Technology
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