Arteriovenous malformation

embocure score:
AVMES
Introduction
Therapeutic decision, management of cerebral AVM a complex.
Grading systems that help to predict the risk of curative
treatment.
the SpetzlerMartin scale microsurgical resection
The advent of new treatment modalities radiosurgery and
embolizationhas enhanced our ability to effectively treat AVMs
There exists no prognostic tool that can be reliably applied to
endovascular embolization of AVMs with the intention of
complete obliteration develop a readily applicable scoring
system to aid in risk-stratifying AVMs for endovascular
embolization
Methods
Retrospective reviewed the medical records of these patients to
obtain relevant information about
their presentation
outcome
procedure
Patients
Inclusion criteria
Patients had a cerebral AVM that had not
been previously treated and underwent
endovascular embolization with Onyx.
Exclusion criteria
prior treatment (microsurgery,
radiosurgery, or embolization),
planned staged multimodal treatment
(microsurgery or radiosurgery)
lack of pre-embolization angiogram or
medical records
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Variable
Vascular
eloquence

Number of
arterial pedicles
Variables
Size of the AVM

Number of
draining veins
1. Vascular eloquence of the arterial feeders

An arteriovenous malformation (AVM) was

deemed eloquent if the arterial pedicle was
<20 mm from the internal carotid artery or
the first segment of cerebral arteries (eg,
A1, M1, P1 segments) or too small for
microcatheterization
 2. Number of Arterial Pedicles

grade 1 : 13 arteria pedicles grade 2 : 46 arteria pedicles grade 3 : > 6 arteria pedicles
 3. Size of The Nidus

grade 1 : <3 cm grade 2 : 36 cm (B) grade 3 : > 6 cm

 4. Number of Draining Veins

Grade 1 : 13 draining veins

Grade 2 : 46 draining veins

Result
Result
Result
 Result
Receiver Operator Characteristic Curve Analysis
Complete AVM obliteration, the AVMES had an area under the curve (AUC) of
0.8240 (95% CI 0.6897 to 0.9582).
Major complications, the AVMES had an AUC 0.7529 (95% CI 0.54105 to
0.96483)
Discussion
The AVMES has significant discriminatory power in distinguishing
AVMs that are at low, intermediate, and high risk of embocure
success.
The patients with AVMs who have an AVMES of 3 have a favorable
risk profile for primary endovascular obliteration of their AVM (100%
obliteration rate without complication)
Patients with a score of 4 or 5 have similar risk profiles, with 67%
achieving complete obliteration without complication.
The patients with AVMES >5 were a high-risk embolization group
Population 39 patients with CAVB

Intervention Primary endovascular onyx embolization

Comparison -

Outcome AVM obliteration and risk of major complication

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Journal Critical Appraisal
RAMMBO Validity Worksheet Answer

Recruitment Were the subjects Yes

representative of the
target population?

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Journal Critical Appraisal
RAMMBO Validity Worksheet Answer

Allocation Was the treatment Yes

allocation concealed
before randomization
and were the groups
comparable at the start
of the trial?

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Journal Critical Appraisal
RAMMBO Validity Worksheet Answer

Maintenance Was the comparable status Yes

of the study groups
maintained through equal
management? And
adequate follow up?

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Journal Critical Appraisal
RAMMBO Validity Worksheet Answer

Measurement Were the outcomes Yes

Blinding measured with blinded
Outcome subjects and assessors,
and/or objective
outcomes?

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IMPORTANCY
Importancy
Worksheet Answer
Therapy

Is statistical significance and

clinical significance of the
results reflected well ?

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Applicability
No Applicability Answer

1 Were the patient quite similar to the patients in the YES

study?
2 Were the indicator in this study can be applied to the YES
management of patients in your neighborhood?
3 Were the outcomes of this research important for your YES
patient?

4 Will the potential benefit is greater than the potential YES

harm when this indicator is applied to your patients ?
5 Will the results of this research can be integrated YES
with the values and expectations of your patients ?

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CONCLUSION
No formal grading system is currently available to aid in the risk
assessment of endovascular embolization of AVMs with Onyx.
We present the endovascular AVM score to fulfill the need for such a
tool.
The endovascular AVM score provides a simple, intuitive, easily assessed
scoring system that robustly discriminates between groups with
favorable, intermediate, and unfavorable risk profiles to achieve a
curative endovascular embolization
Though validation prospectively and with long-term follow-up is needed,
we hope this tool will aid in the assessment and therapeutic decision-
making of microsurgeons, radiosurgeons, and endovascular surgeons in
their management of AVMs.
CONCLUSION

This journal can be classifed as a VALID journal

IMPORTANCY in this journal were described well
Result from the research in this journal is APPLICABLE

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THANK YOU

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