In:
Frontiers in Pediatrics, Frontiers Media SA, Vol. 10 ( 2022-9-30)
Abstract:
Understanding outcomes after Vein of Galen malformation (VOGM) embolization has been limited by small sample size in reported series and predominantly single center studies. To address these limitations, we perform an individual-participant meta-analysis (IPMA) to identify risk factors associated with all-cause mortality and clinical outcome after VOGM endovascular embolization. Methods We performed a systematic review and IPMA of VOGM endovascular outcomes according to PRISMA guidelines. Individual patient characteristics including demographic, intra/post-operative adverse events, treatment efficacy (partial or complete occlusion), and clinical outcome were collected. Mixed-effects logistic regression with random effects modeling and Bonferroni correction was used ( p ≤ 0.003 threshold for statistical significance). The primary and secondary outcomes were all-cause mortality and poor clinical outcome (moderate/severe developmental delay or permanent disabling injury), respectively. Data are expressed as (mean ± standard deviation (SD)) or (odds ratio (OR), 95% confidence interval (CI), I 2 , p -value) Results Thirty-five studies totaling 307 participants quantifying outcomes after endovascular embolization for VOGM were included. Follow up time was 42 (±57) months. Our analysis contained 42% neonates ( & lt;1 month) at first embolization, 45% infants (1 month ≤2 years), and 13% children ( & gt;2 years). Complete occlusion was reported in 48% of participants. Overall all-cause mortality was 16%. Overall, good clinical outcome was achieved in 68% of participants. First embolization as a neonate [OR = 6.93; 95% CI (1.99–24.08); I 2 & lt; 0.01; p & lt; 0.001] and incomplete embolization [OR = 10.87; 95% CI (1.86–63.55); I 2 & lt; 0.01; p & lt; 0.001] were associated with mortality. First embolization as a neonate [OR = 3.24; 95% CI (1.47–7.15); I 2 & lt; 0.01; p & lt; 0.001], incomplete embolization [OR = 5.26; 95% CI (2.06–13.43); I 2 & lt; 0.01; p & lt; 0.001], and heart failure at presentation [OR = 3.10; 95% CI (1.03–9.33); I 2 & lt; 0.01; p = 0.002] were associated with poor clinical outcomes. Sex, angioarchitecture of lesion, embolization approach (transvenous vs. transarterial), and single or multistage embolization were not associated with mortality or clinical outcome. Conclusions We identify incomplete VOGM embolization independently associated with mortality and poor clinical outcome. While this study provides the highest level of evidence for VOGM embolization to date, prospective multicenter studies are needed to understand the optimal treatment strategies, outcomes, and natural history after VOGM embolization.
Type of Medium:
Online Resource
ISSN:
2296-2360
DOI:
10.3389/fped.2022.976060
DOI:
10.3389/fped.2022.976060.s001
Language:
Unknown
Publisher:
Frontiers Media SA
Publication Date:
2022
detail.hit.zdb_id:
2711999-3
