Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial
- Type de publi. : Article dans une revue
- Date de publi. : 28/10/2022
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Auteurs :
Jean RaymondJean-Christophe GentricElsa MagroLorena NicoEmma BacchusRuby KlinkChristophe CognardAnne-Christine JanuelJean-François SabatierDaniela IancuAlain WeillDaniel RoyMichel BojanowskiChiraz ChaalalaXavier BarreauVincent JeckoChrysanthi PapagiannakiStéphane DerreyEimad ShotarPhilippe CornuOmer EkerIsabelle Pelissou-GuyotatMichel PiotinSorin AldeaRémy BeaujeuxFrançois ProustRené AnxionnatVincent CostalatMarine Le CorreJean-Yves GauvritXavier MorandiHervé BrunelPierre-Hugues RocheThomas GraillonEmmanuel ChabertDenis HerbreteauHubert DesalDenis TrystramCharlotte BarbierThomas GaberelThanh NguyenGeraldine ViardGuylaine GevryTim DarsautCian O’kellyMichael ChowJ. Max FindlayJeremy RempelRobert FahedHoward LesiukBrian DrakeMarlene Dos SantosMichel NonentJulien OgnardMourad Cheddad El-AouniRomuald SeizeurSerge TimsitOlivier PradierRomain BoursierFrançois ThillaysVincent RoualdesRaphael BlancLionel CalviereJean Yves GauvritHélène RaoultFrançois EugeneAnthony Le BrasJean-Christophe FerreChristophe PayaIsabelle LecouillardElodie NouhaudThomas RonziereOlivier NaggaraChristine Rodriguez-RegentBasile KerlerouxEvelyne EmeryEmmanuel TouzeRoberto RivaIsabelle Pellisou-GuyotatJacques GuyotatMonsef BerhoumaChloé DumotAlessandra BiondiLaurent ThinesNassim BougaciGuillaume CharbonnierSerge BracardBenjamin GoryThierry CivitValérie Bernier-ChastagnerGaultier MarnatGuillaume PenchetEdouard GimbertAymeri HuchetGrégoire BoulouisRichard BibiHéloïse IferganKévin JanotStéphane VelutHadrien PeyriereJean-Marc KayaAdamou ToutaLucas TroudeSébastien BoissonneauFrédéric ClarençonNader SourourStéphanie LenckKévin PrematAnne-Laure BochAurélien NouetAlain BonafeCyril DargazanliGregory GascouPierre-Henri LefevreCarlos RiquelmeRaoul PopHélène CebulaIrène OllivierGiorgio SpatolaLaurent SpellVanessa ChalumeauSophie GallasLéon IkkaCristian MihaleaAugustin OzanneJildaz CaroffCharbel MounayerAymeric RouchaudFrançois CaireFrédéric RicolfiPierre ThouantCatherine CaoKlaus-Luc MourierWalid FarahMohamad AbdalkaderThien HuynhRabih TawkAndrew CarlsonLuciana Alves Oliveira SilvaNayara de Lima FroioGisele Sampaio SilvaFrancisco Mont’alverneJose Luri MartinsGeorge Nunes MendesRodrigo Rivera Miranda
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Organismes :
Centre Hospitalier de l'Université de Montréal
Service de Neuroradiologie [Brest]
Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé - Brest
Laboratoire de Traitement de l'Information Medicale
Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
University of Alberta
Centre Hospitalier de l'Université de Montréal
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Service Neurochirurgie [CHU Toulouse]
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier de l'Université de Montréal
Université du Québec à Montréal = University of Québec in Montréal
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier Universitaire de Bordeaux
Centre Hospitalier Universitaire de Bordeaux
CHU Rouen
Service de Neurochirurgie [CHU Rouen]
Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
Institute for Research and Innovation in Biomedicine
Centre d'Investigation Clinique [CHU Rouen]
UNIROUEN - UFR Santé
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
Service de neuroradiologie [Lyon]
Hospices Civils de Lyon
Centre Hospitalier de l'Université de Montréal
- Publié dans Journal of Neurosurgery le 26/10/2020
Résumé : Objective: The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries. Methods: Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2. Results: From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%-22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%-28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%-25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%-21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%-37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%-20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%-40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%-21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%-35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%-29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%-33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%-34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%-26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%-34%). Conclusions: Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial. Trial registration: ClinicalTrials.gov NCT02098252.
Fichiers liés :
Raymond2022.pdf
Source