{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T15:08:31Z","timestamp":1761664111069,"version":"build-2065373602"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To establish a nasal endoscopic vascular grading system for predicting epistaxis severity and guiding stepwise therapy in hereditary hemorrhagic telangiectasia (HHT).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort of 32 HHT patients from 22 families was classified via 1080p endoscopy into three grades: Grade I: Sparse punctate telangiectases; Grade II: Dense confluent vessels; Grade III: Protruding hemangiomas. Demographics, Epistaxis Severity Score (ESS), hemoglobin levels (Hb), systemic vascular lesions, and ENG\/ACVRL1 mutations were analyzed. Treatment outcomes were compared across grades.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Grade I accounted for 18.8%, Grade II for 34.4%, and Grade III for 46.9%. Grade III patients showed the highest ESS (6.31\u2009\u00b1\u20092.13 vs. 1.21\u2009\u00b1\u20090.92 for Grade I,\n p<\/jats:italic>\n \u2009<\u20090.01) and the lowest Hb (97.2\u2009\u00b1\u200922.4 vs. 129.5\u2009\u00b1\u20094.9\u2009g\/L for Grade I,\n p<\/jats:italic>\n \u2009<\u20090.05), and had more systemic lesions (80.0% of Grade III patients had hand\/oral\/visceral hemangiomas vs. 16.7% in Grade I,\n p<\/jats:italic>\n \u2009<\u20090.01). Local therapies or tranexamic acid treatment sufficed for Grade I\/II patients, who maintained stable ESS. Among Grade III patients who showed no improvement after treatment with tranexamic acid, bevacizumab (administered at a dose of 5\u2009mg\/kg every 3\u20136\u2009months) improved the ESS and increased the Hb in 62.5% of the patients (5 out of 8), and no severe adverse events occurred.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study preliminarily confirms a significant correlation between nasal endoscopic vascular morphology and HHT epistaxis severity, guiding disease assessment and treatment planning.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n 3.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lio2.70272","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T10:16:14Z","timestamp":1759832174000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Vascular Grading Directs Stepwise Therapy in Hereditary Hemorrhagic Telangiectasia"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1917-652X","authenticated-orcid":false,"given":"Hong\u2010Gang","family":"Duan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology The Second Affiliated Hospital, Zhejiang University Scholl of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology The Second Affiliated Hospital, Zhejiang University Scholl of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin\u2010Rong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology The Second Affiliated Hospital, Zhejiang University Scholl of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke\u2010Jia","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology The Second Affiliated Hospital, Zhejiang University Scholl of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen\u2010Yuan","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology The Second Affiliated Hospital, Zhejiang University Scholl of Medicine Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1443"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2009.35"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmg.2021.104370"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203720"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23893"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1743467"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24526"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20818"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-017-0647-8"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-021-01801-9"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3263"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21339"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240602000116"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-020-1337-5"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9113571"},{"issue":"5","key":"e_1_2_9_17_1","first-page":"436","article-title":"Effects of Bevacizumab on Familial Epistaxis Caused by Hereditary Hemorrhagic Telangiectasia","volume":"56","author":"Zhang J.","year":"2021","journal-title":"Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin16.315"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.21053\/ceo.2016.00318"}],"container-title":["Laryngoscope Investigative 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