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  • Association of the combined stereotactic radiosurgery and embolization strategy and long-term outcomes in brain arteriovenous malformations with a volume ≤10 mL: a nationwide multicenter observational prospective cohort study

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Hemorrhagic stroke
Original research
Association of the combined stereotactic radiosurgery and embolization strategy and long-term outcomes in brain arteriovenous malformations with a volume ≤10 mL: a nationwide multicenter observational prospective cohort study
  1. Hengwei Jin1,
  2. Zhipeng Li2,
  3. Dezhi Gao3,
  4. Yu Chen2,
  5. Heze Han2,
  6. Li Ma2,
  7. Debin Yan4,
  8. Ruinan Li2,
  9. Anqi Li2,
  10. Haibin Zhang2,
  11. Kexin Yuan2,
  12. Yukun Zhang5,
  13. Yang Zhao5,
  14. Xiangyu Meng6,
  15. Youxiang Li1,
  16. Xiaolin Chen2,7,8,
  17. Hao Wang2,7,8,
  18. Shibin Sun3,
  19. Yuanli Zhao2,7,8
  1. 1 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3 Department of Gamma-Knife center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  4. 4 Department of Neurosurgery, Shanxi Provincial People’s Hospital, Shanxi, China
  5. 5 Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
  6. 6 Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, China
  7. 7 China National Clinical Research Center for Neurological Diseases, Beijing, China
  8. 8 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  1. Correspondence to Dr Yuanli Zhao, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; zhaoyuanli{at}126.com; Dr Shibin Sun, Department of Gamma-Knife center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; tiantan_sunshibin{at}163.com

Abstract

Background To compare the long-term outcomes of stereotactic radiosurgery (SRS) with or without prior embolization in brain arteriovenous malformations (AVMs) (volume ≤10 mL) for which SRS is indicated.

Methods Patients were recruited from a nationwide multicenter prospective collaboration registry (the MATCH study) between August 2011 and August 2021, and categorized into combined embolization and SRS (E+SRS) and SRS alone cohorts. We performed propensity score-matched survival analysis to compare the long-term risk of non-fatal hemorrhagic stroke and death (primary outcomes). The long-term obliteration rate, favorable neurological outcomes, seizure, worsened mRS score, radiation-induced changes, and embolization complications were also evaluated (secondary outcomes). Hazard ratios (HRs) were calculated using Cox proportional hazards models.

Results After study exclusions and propensity score matching, 486 patients (243 pairs) were included. The median (IQR) follow-up duration for the primary outcomes was 5.7 (3.1–8.2) years. Overall, E+SRS and SRS alone were similar in preventing long-term non-fatal hemorrhagic stroke and death (0.68 vs 0.45 per 100 patient-years; HR=1.46 (95% CI 0.56 to 3.84)), as well as in facilitating AVM obliteration (10.02 vs 9.48 per 100 patient-years; HR=1.10 (95% CI 0.87 to 1.38)). However, the E+SRS strategy was significantly inferior to the SRS alone strategy in terms of neurological deterioration (worsened mRS score: 16.0% vs 9.1%; HR=2.00 (95% CI 1.18 to 3.38)).

Conclusions In this observational prospective cohort study, the combined strategy of E+SRS does not show substantial advantages over SRS alone. The findings do not support pre-SRS embolization for AVMs with a volume ≤10 mL.

  • Arteriovenous Malformation
  • Hemorrhage
  • Stroke

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/jnis-2023-020289

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • HJ and ZL contributed equally.

    • Contributors HJ and ZL conceptualized and designed the study. DG, DY, RL, AL, HZ, KY, and XM collected the data. YC, HH, and LM performed the statistical analysis. ZL wrote the manuscript. YukZ and YaZ assessed the radiological follow-up results. YC, XC, and YuaZ funded the study. YL, XC, HW, SS, and YuaZ critically revised the manuscript and approved the final manuscript as submitted. YuaZ, as the guarantor, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was supported by the National Key Research and Development Program of China (Grant No. 2022YFB4702800 to YuaZ, and No. 2021YFC2501101 and 2020YFC2004701 to XC), Natural Science Foundation of China (grant no. 81771234 and 82071302 to YuaZ, and 82202244 to YC).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.