{"title":"Transarterial AVM embolization using Tsinghua grading system: Patient selection and complete obliteration","authors":"Huachen Zhang , Youle Su , Shikai Liang , Xianli Lv","doi":"10.1016/j.neuri.2024.100160","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Key messages</h3><p>The Tsinghua grading system for endovascular AVM embolization will guide patient selection of AVM embolization.</p></div>","PeriodicalId":74295,"journal":{"name":"Neuroscience informatics","volume":"4 2","pages":"Article 100160"},"PeriodicalIF":0.0000,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772528624000050/pdfft?md5=400f1baddd7785f93f9d201a35837df4&pid=1-s2.0-S2772528624000050-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroscience informatics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772528624000050","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
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.
Neuroscience informaticsSurgery, 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