| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Doris and Stanley Tananbaum Stroke Center/Neurological Institute (C.S., H.M., J.H.C., A.V.K., J.P.M.), Department of Internal Medicine (R.R.S.), Division of Neurosurgery/Neurological Institute (E.S.C.), and Interventional Neuroradiology/Department of Radiology (J.P.-S.), Columbia University, New York, NY; Department of Neurology (H..M.), BG Kliniken Bergmannstrost, Halle/Salle, Germany; and Department of Neurology (C.S.), Hôpital Lariboisière, AP-HP, Paris, France.
Address correspondence and reprint requests to Dr. C. Stapf, Stroke Center/Neurological Institute, Columbia University, 710 W. 168 Street, New York, NY 10032; e-mail: cstapf{at}neuro.columbia.edu
Background: Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been established, but their relevance for the risk of subsequent AVM hemorrhage remains unclear.
Methods: The authors analyzed follow-up data on 622 consecutive patients from the prospective Columbia AVM database, limited to the period between initial AVM diagnosis and the start of treatment (i.e., any endovascular, surgical, or radiation therapy). Univariate and multivariate logistic regression and Cox proportional hazard models were applied to analyze the effect of patient age, gender, AVM size, anatomic location, venous drainage pattern, and associated arterial aneurysms on the risk of intracranial hemorrhage at initial presentation and during follow-up.
Results: The mean pretreatment follow-up was 829 days (median: 102 days), during which 39 (6%) patients experienced AVM hemorrhage. Increasing age (hazard ratio [HR] 1.05, 95% CI 1.03 to 1.08), initial hemorrhagic AVM presentation (HR 5.38, 95% CI 2.64 to 10.96), deep brain location (HR 3.25, 95% CI 1.30 to 8.16), and exclusive deep venous drainage (HR 3.25, 95% CI 1.01 to 5.67) were independent predictors of subsequent hemorrhage. Annual hemorrhage rates on follow-up ranged from 0.9% for patients without hemorrhagic AVM presentation, deep AVM location, or deep venous drainage to as high as 34.4% for those harboring all three risk factors.
Conclusions: Hemorrhagic arteriovenous malformation (AVM) presentation, increasing age, deep brain location, and exclusive deep venous drainage appear to be independent predictors for AVM hemorrhage during natural history follow-up. The risk of spontaneous hemorrhage may be low in AVMs without these risk factors.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 9 issue to find the title link for this article.
Supported by NIH grant R01 NS 40792–01 (J.P.M.).
Disclosure: The authors report no conflicts of interest.
Received August 11, 2005. Accepted in final form January 20, 2006.
Related Article
Neurology 2006 66: 1292-1293.
This article has been cited by other articles:
|
|
 |
|
  R. A.-S. Salman, D. L Labovitz, and C. Stapf Spontaneous intracerebral haemorrhage BMJ, July 24, 2009; 339(jul24_1): b2586 - b2586. [Full Text]
|
|
|
|
 |
|
 P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation, April 28, 2009; 119(16): 2235 - 2249. [Full Text] [PDF]
|
|
|
|
 |
|
 L da Costa, L Thines, A R Dehdashti, M C Wallace, R A Willinsky, M Tymianski, M L Schwartz, and K G t. Brugge Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience J. Neurol. Neurosurg. Psychiatry, April 1, 2009; 80(4): 376 - 379. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. van Beijnum, C. E. Lovelock, C. Cordonnier, P. M. Rothwell, C. J. M. Klijn, R. Al-Shahi Salman, and on behalf of the SIVMS Steering Committee and the Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies Brain, February 1, 2009; 132(2): 537 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Panagiotopoulos, E. Gizewski, S. Asgari, J. Regel, M. Forsting, and I. Wanke Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx) AJNR Am. J. Neuroradiol., January 1, 2009; 30(1): 99 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T.J. Hodgson, A.A. Kemeny, A. Gholkar, and N. Deasy Embolization of Residual Fistula Following Stereotactic Radiosurgery in Cerebral Arteriovenous Malformations AJNR Am. J. Neuroradiol., January 1, 2009; 30(1): 109 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. da Costa, M. C. Wallace, K. G. ter Brugge, C. O'Kelly, R. A. Willinsky, and M. Tymianski The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations Stroke, January 1, 2009; 40(1): 100 - 105. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. van Beijnum, J. J. Bhattacharya, C. E. Counsell, V. Papanastassiou, V. Ritchie, R. C. Roberts, R. J. Sellar, C. Warlow, R. A.-S. Salman, and on behalf of the SIVMS Collaborators Patterns of Brain Arteriovenous Malformation Treatment: Prospective, Population-Based Study Stroke, December 1, 2008; 39(12): 3216 - 3221. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Stapf and J.P. Mohr Unruptured Brain Arteriovenous Malformations Should Be Treated Conservatively: Yes Stroke, December 1, 2007; 38(12): 3308 - 3309. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Cockroft Unruptured Brain Arteriovenous Malformations Should Be Treated Conservatively: No Stroke, December 1, 2007; 38(12): 3310 - 3311. [Full Text] [PDF]
|
|
|
|
|
|
H. Kim, S. Sidney, C. E. McCulloch, K. Y. T. Poon, V. Singh, S. C. Johnston, N. U. Ko, A. S. Achrol, M. T. Lawton, R. T. Higashida, et al. Racial/Ethnic Differences in Longitudinal Risk of Intracranial Hemorrhage in Brain Arteriovenous Malformation Patients Stroke, September 1, 2007; 38(9): 2430 - 2437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Khaw When Race/Ethnicity Matters More Than Size Stroke, September 1, 2007; 38(9): 2405 - 2406. [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Friedlander Arteriovenous Malformations of the Brain N. Engl. J. Med., June 28, 2007; 356(26): 2704 - 2712. [Full Text] [PDF]
|
|
|
|
|
|
I. Linfante and A. K. Wakhloo Brain Aneurysms and Arteriovenous Malformations: Advancements and Emerging Treatments in Endovascular Embolization Stroke, April 1, 2007; 38(4): 1411 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Dashe, C. Stapf, and J .P. Mohr Predictors of hemorrhage in patients with untreated brain arteriovenous malformation Neurology, February 13, 2007; 68(7): 535 - 535. [Full Text] [PDF]
|
|
Read all Correspondence
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
