Interventional Treatment vs Conservative Management of Unruptured Brain Arteriovenous Malformations

作者：Heze Han, Yú Chen, Li Ma, Hengwei Jin, Dezhi Gao, Zhipeng Li, Ruinan Li, Haibin Zhang, Kexin Yuan, Anqi Li, Tengfei Yu, Qinghui Zhu, Chengzhuo Wang, Yukun Zhang, Hongwei Zhang, Debin Yan, Xiaofeng Chao, Zhengfeng Lin, Youxiang Li, Shibin Sun, Yuanli Zhao, Xiaolin Chen, Shuo Wang, Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH) Registry, Qiang Hao, Hao Wang, Shuai Kang, Xun Ye, Yahui Zhao, Fa Lin, Runting Li, Ke Wang, Yingying Su, Cunyang Li, Weitao Jin, Changyu Lu, Yang Zhao, Yunfan Zhou, Geng Guo, Xiangyu Meng, Jun Pu, Zhiyong Shi, Qiang Wang, Junlin Lu, Weiwei Chen · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.43408 · 被引用次数：1 · 研究领域：Vascular Malformations Diagnosis and Treatment、Intracranial Aneurysms: Treatment and Complications、Vascular Anomalies and Treatments

Importance: The optimal management of unruptured brain arteriovenous malformations (AVMs) remains controversial, as the risk-benefit balance between interventional treatment and conservative management is unclear. While ARUBA (A Randomized Trial of Unruptured Brain AVMs) favored conservative management in the short term, methodologic limitations and limited follow-up have left uncertainty regarding long-term outcomes. Objective: To evaluate the association between interventional treatment and hemorrhage-free survival, compared with conservative management, in patients with unruptured AVMs. Design, Setting, and Participants: This cohort study used a target trial emulation approach based on data from the Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (MATCH) registry, a nationwide, multicenter prospective collaboration conducted from August 1, 2011, to December 31, 2021. Patients with unruptured AVMs at baseline were included. Data analyses were conducted from January 24 to April 6, 2025. Exposures: Interventional treatment (microsurgical resection, stereotactic radiosurgery, endovascular embolization, or combinations thereof) initiated within 6 months of diagnosis vs conservative management (observation and medical therapy). Main Outcomes and Measures: The primary outcome was 5-year hemorrhage-free survival, defined as survival without AVM-related hemorrhage or death. The secondary outcome was 10-year hemorrhage-free survival. Hazard ratios (HRs...