Transarterial AVM embolization using Tsinghua grading system: Patient selection and complete obliteration - 06/04/24

Doi : 10.1016/j.neuri.2024.100160

Huachen Zhang ^b,^{^{1
Huachen Zhang and Youle Su contributed equally to this article.}}, Youle Su ^a,^{^{1
Huachen Zhang and Youle Su contributed equally to this article.}}, Shikai Liang ^b, Xianli Lv ^b,^{^⁎}
^a Department of Neurosurgery, Inner Mongolia Medical University Affiliated Hospital, Hohhot, Inner Mongolia, China
^b Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China

^⁎Corresponding author at: Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Litang Road 168, 102218, Beijing, China.Department of NeurosurgeryBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityLitang Road 168Beijing102218China

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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.