Embolization of Brain Arteriovenous Malformations With Versus Without Onyx Before Stereotactic Radiosurgery
| العنوان: | Embolization of Brain Arteriovenous Malformations With Versus Without Onyx Before Stereotactic Radiosurgery |
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| المؤلفون: | Monica Mureb, Ronald E Warnick, Heath B. Mackley, Jason P. Sheehan, Rafael Rodriguez-Mercado, David Mathieu, Jaromir Hanuska, Shiao Y. Woo, Christopher P. Cifarelli, Varun Padmanaban, David E. Arsanious, Cheng-Chia Lee, Douglas Kondziolka, Mehran Yusuf, Neel T. Patel, Carolina Benjamin, Dale Ding, Samer G. Zammar, Caleb E Feliciano, Anissa Saylany, Natasha Ironside, John Y K Lee, Kathryn N. Kearns, Daniel M. Trifiletti, Roman Liscak, I. Jonathan Pomeraniec, Scott D. Simon, Nathan Beatson, Brian J. Williams, Kevin M. Cockroft, Ching-Jen Chen |
| المصدر: | Neurosurgery. 88:366-374 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Adult, Intracranial Arteriovenous Malformations, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Radiosurgery, Asymptomatic, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, parasitic diseases, medicine, Humans, Embolization, Stroke, Retrospective Studies, business.industry, Arteriovenous malformation, Odds ratio, Middle Aged, medicine.disease, Embolization, Therapeutic, Treatment Outcome, Cohort, Female, Polyvinyls, Surgery, Neurology (clinical), Radiology, medicine.symptom, Complication, business, 030217 neurology & neurosurgery |
| الوصف: | Background Embolization of brain arteriovenous malformations (AVMs) using ethylene-vinyl alcohol copolymer (Onyx) embolization may influence the treatment effects of stereotactic radiosurgery (SRS) differently than other embolysates. Objective To compare the outcomes of pre-SRS AVM embolization with vs without Onyx through a multicenter, retrospective matched cohort study. Methods We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Embolized AVMs treated with SRS were selected and categorized based on embolysate usage into Onyx embolization (OE + SRS) or non-Onyx embolization (NOE + SRS) cohorts. The 2 cohorts were matched in a 1:1 ratio using de novo AVM features for comparative analysis of outcomes. Results The matched cohorts each comprised 45 patients. Crude AVM obliteration rates were similar between the matched OE + SRS vs NOE + SRS cohorts (47% vs 51%; odds ratio [OR] = 0.837, P = .673). Cumulative probabilities of obliteration were also similar between the OE + SRS vs NOE + SRS cohorts (subhazard ratio = 0.992, P = .980). Rates of post-SRS hemorrhage, all-cause mortality, radiation-induced changes, cyst formation, and embolization-associated complications were similar between the matched cohorts. Sensitivity analysis for AVMs in the OE + SRS cohort embolized with Onyx alone revealed a higher rate of asymptomatic embolization-associated complications in this subgroup compared to the NOE + SRS cohort (36% vs 15%; OR = 3.297, P = .034), but the symptomatic complication rates were similar. Conclusion Nidal embolization using Onyx does not appear to differentially impact the outcomes of AVM SRS compared with non-Onyx embolysates. The embolic agent selected for pre-SRS AVM embolization should reflect both the experience of the neurointerventionalist and target of endovascular intervention. |
| تدمد: | 1524-4040 0148-396X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::466c7ccc5acc6293b7159227327da92bTest https://doi.org/10.1093/neuros/nyaa370Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....466c7ccc5acc6293b7159227327da92b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15244040 0148396X |
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