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Recurrence of Cerebral Arteriovenous Malformation Following Complete Obliteration Through Endovascular Embolization

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Abstract

Arteriovenous malformation (AVM) recurrence after embolization was rarely reported. This study aimed to explore the potential risk factors of recurrence in angiographically obliterated AVMs treated with endovascular embolization. This study reviewed AVMs treated with embolization only in a prospective multicenter registry from August 2011 to December 2021, and ultimately included 92 AVMs who had achieved angiographic obliteration. Recurrence was assessed by follow-up digital subtraction angiography (DSA) or magnetic resonance imaging (MRI). Hazard ratios (HRs) with 95% confidence intervals were calculated using Cox proportional hazards regression models. Nineteen AVMs exhibited recurrence on follow-up imaging. The recurrence rates after complete obliteration at 6 months, 1 year, and 2 years were 4.35%, 9.78%, and 13.0%, respectively. Multivariate Cox regression analysis identified diffuse nidus (HR 3.208, 95% CI 1.030–9.997, p=0.044) as an independent risk factor for recurrence. Kaplan–Meier analysis confirmed a higher cumulative risk of recurrence with diffuse nidus (log-rank, p=0.016). Further, in the exploratory analysis of the effect of embolization timing after AVM rupture on recurrence after the complete obliteration, embolization within 7 days of the hemorrhage was found as an independent risk factor (HR 4.797, 95% CI 1.379–16.689, p=0.014). Kaplan–Meier analysis confirmed that embolization within 7 days of the hemorrhage was associated with a higher cumulative risk of recurrence in ruptured AVMs (log-rank, p<0.0001). This study highlights the significance of diffuse nidus as an independent risk factor for recurrence after complete embolization of AVMs. In addition, we identified a potential recurrent risk associated with early embolization in ruptured AVMs.

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Acknowledgements

We thank the patients and neurointerventionists who participated in this study for their help.

Funding

This work was supported by the National Key Research and Development Program of China (Grant No. 2022YFB4702800 to Yuanli Zhao, and No. 2021YFC2501101 and 2020YFC2004701 to Xiaolin Chen), Natural Science Foundation of China (grant no. 81771234 and 82071302 to Yuanli Zhao, and 82202244 to Yu Chen).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Qiang Hao, Haibin Zhang, Heze Han, Li Ma, Ruinan Li, Zhipeng Li, Anqi Li, Kexin Yuan, Qinghui Zhu, Ke Wang, Runting Li, Fa Lin, Chengzhuo Wang, Shuai Kang, Xun Ye, Hao Wang, Yu Chen, Xiaolin Chen & Yuanli Zhao

  2. Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China

    Hengwei Jin & Youxiang Li

  3. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China

    Yukun Zhang, Hongwei Zhang, Yang Zhao & Weitao Jin

  4. Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Dezhi Gao & Shibin Sun

  5. Department of Emergency, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China

    Geng Guo

  6. Department of Neurosurgery, Shanxi Provincial People’s Hospital, Xi’an, Shanxi, China

    Debin Yan

  7. Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China

    Jun Pu

  8. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Yu Chen, Xiaolin Chen & Yuanli Zhao

  9. Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Yu Chen, Xiaolin Chen & Yuanli Zhao

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  1. Qiang Hao
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Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH)

Contributions

QH and HZ conceptualized and orchestrated the study’s design. HJ, RL, ZL, AL, KY, KW, YZ, QZ, CW, and DY collected the data. YC, HH, LM, and HZ conducted the statistical analysis. HZ wrote the manuscript. HZ, WJ, and YZ assessed the follow-up imaging results. YC, XC, and YZ provided the financial support for the study. YL, SS, XC, and YZ critically scrutinized the manuscript, rendering their invaluable revisions and granting their full approval for the final submission. The others provided valuable comments on the supplement of the scheme design as well as the revision of the draft. All authors reviewed the manuscript. All authors unanimously committed to being accountable for every facet of this work, ensuring the rigorous investigation and resolution of any questions pertaining to its accuracy and integrity.

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Correspondence to Hao Wang, Yu Chen, Xiaolin Chen or Yuanli Zhao.

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Qiang Hao and Haibin Zhang are co-first authors

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Hao, Q., Zhang, H., Han, H. et al. Recurrence of Cerebral Arteriovenous Malformation Following Complete Obliteration Through Endovascular Embolization. Transl. Stroke Res. (2023). https://doi.org/10.1007/s12975-023-01215-8

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