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目的分析脑动静脉畸形(AVM)经α-氰基丙烯酸正丁酯(NBCA)栓塞治疗的风险;研究影响栓塞效果的血管构筑因素,建立脑 AVM 血管内治疗的分级系统。方法回顾性分析189例经NBCA 栓塞治疗的脑 AVM 患者的临床资料、血管特征、栓塞并发症以及栓塞的程度。采用多元回归分析,探寻血管构筑特性与 NBCA 栓塞治疗脑 AVM 的栓塞效果及并发症发生率间的关系,基于畸形的大小[(纯动静脉瘘)为0分、畸形血管团最大径<30 mm 为1分、≥30 mm 为2分],一级供血动脉数(1根为0分、2～3根为1分、≥4根为2分),二级供血动脉数(≤3根为0分、≥4根为1分)建立血管构筑分级系统,分级系统根据积分的高低分为6级(0～Ⅴ级)。结果 189例脑 AVM 患者,共行324次 NBCA 栓塞治疗;手术相关病死率为1.6%(3/189),永久神经功能缺损性并发症的发生率为2.6%(5/189)。31例纯动静脉瘘和Ⅰ级 AVM 完全栓塞24例(77.4%);101例Ⅳ级、Ⅴ级的 AVM 患者82例(81.2%)栓塞程度在50%以下,没有完全栓塞病例,分级与栓塞程度的吻合度较强(κ=0.736,P<0.01)。结论血管构筑评级系统能很好地预测 NBCA 栓塞治疗脑 AVM 的难度及效果。结合 AVM 的 Spetzler,评分,可以更合理地制定治疗方案。
Objective To analyze the risk of cerebral arteriovenous malformation (AVM) embolization by α-cyano-n-butylacrylate (NBCA), to study the factors that affect the embolization effect and to establish the grading system of endovascular AVM treatment. Methods The clinical data, vascular characteristics, embolism complications and embolism of 189 patients with brain AVM treated with NBCA embolization were retrospectively analyzed. Multivariate regression analysis was used to explore the relationship between the characteristics of vascular architecture and embolization of AVM with NBCA embolization and the incidence of complications. Based on the magnitude of deformity (pure arteriovenous fistula), 0, the maximum diameter of abnormal vascular mass was less than 30 mm (1 for 0, 2 for 3, 1 for 2, and 2 for ≥30), and the number of secondary feeding arteries (≤3 was 0 points, ≥4 points for 1 point) to establish vascular grading system, grading system according to the level of points is divided into 6 (0 ~ V grade). Results A total of 189 patients with brain AVM underwent 324 NBCA embolizations. The operative mortality was 1.6% (3/189). The incidence of permanent neurological deficit complication was 2.6% (5/189). There were 24 cases (77.4%) of pure arteriovenous fistula and grade Ⅰ AVM completely embolized in 31 cases, 82 cases (81.2%) of 101 cases of grade IV and V AVM were less than 50%. There were no complete embolization cases, grade and embolism Degree of coincidence is stronger (κ = 0.736, P <0.01). Conclusion The angioplasty rating system can predict the difficulty and effect of NBCA embolization in the treatment of brain AVM. Combined with the AVM Spetzler, score, a more rational formulation of treatment options.