Embolization before Radiosurgery Reduces the Obliteration Rate of Arteriovenous Malformations
Bibliographic record
Abstract
In Reply: Our article (1) was a clinical study that did not have the objective of discussing the underlying biological background. However, the letter by Sure et al. as well as their previous publications about the biological processes in AVMs that follow embolization are a very important and stimulating addition to this subject. The nonstatic behavior of AVMs, even after an “angiographic cure” by microsurgery, radiosurgery, or embolization, is not a new concept (2,3,6–8). The up-regulation of vasogenic agents induced by changes in the AVM milieu after partial treatment has been implicated in this mechanism (11,12). The effect of interference by these induced proteins in subsequent treatments is an interesting matter under research at present (13). More than 70 genes are differentially expressed in AVMs (4,5,9). Sure et al. (10) have previously demonstrated that partial embolization of AVMs induces local hypoxia, which provokes up-regulation of neoangiogenesis-related molecules. These same molecules are also implicated in the proliferation and de novo generation of AVMs (11). Theoretically, increasing these molecules would negatively influence the radiosurgical result; nevertheless, this consideration still needs to be proved for AVMs, even though it has been demonstrated in other diseases in which vasogenic proteins are implicated. This certainly is another possible mechanism to add to better-known explanations for worse outcomes after radiosurgery for AVMs, such as the difficulty in targeting the more complex shapes of embolized AVMs, recanalization after embolization, and attenuation of the delivered radiation dose because of heavy molecules (iodine in iodized oil [e.g., Lipiodol; Lafayette Pharmacal, Lafayette, IN]) in the glue admixture used for the endovascular treatment of AVMs. These provocative comments raise some practical questions: How stable is the obliteration after an AVM has been occluded with partial embolization followed by radiosurgery? Is the stability of cure the same for microsurgery, embolization, and radiosurgery? Should patients who undergo these treatments continue to be followed with angiography after one negative angiogram? Yuri M. Andrade-Souza Michael L. Schwartz Toronto, Canada
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".