Cerebral arteriovenous malformations: influence of angioarchitecture on bleeding risk

Kubalek, Ralf; Moghtaderi, Ali; Klisch, Joachim; Berlis, Ansgar; Quiske, A.; Schumacher, Martin

doi:10.1007/s00701-003-0143-x

Cited by 29 publications

(16 citation statements)

References 31 publications

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“…Some studies report increased risk of hemorrhage, 4, 9, 18, 20, 23, 24 while other reports suggest no independent effect. 11, 12, 25 Venous stenosis offered no predictive value in the current study. Of course, cerebral veins that are completely thrombosed are not directly visible on DSA and only inconsistently identifiable on CT and MRI, thus limiting the utility of this measure.…”

Section: Discussioncontrasting

confidence: 74%

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Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

Alexander

Cooke

Nelson³

et al. 2015

AJNR Am J Neuroradiol

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Background and Purpose Intracranial hemorrhage is the most serious outcome for brain arteriovenous malformations (AVM). This study examines associations between venous characteristics of these lesions and intracranial hemorrhage. Materials and Methods Statistical analysis was performed on a prospectively maintained database of brain AVMs evaluated at an academic medical center. DSA, CT, and MRI studies were evaluated to classify lesion side, drainage pattern, venous stenosis, number of draining veins, venous ectasia, and venous reflux. Logistic regression analyses were performed to identify association of these angiographic features with intracranial hemorrhage of any age at initial presentation. Results Exclusively deep drainage (OR 3.42, 95% CI 1.87–6.26, p<0.001) and a single draining vein (OR 1.98, 95% CI 1.26–3.08, p=0.002) were associated with hemorrhage, whereas venous ectasia (OR 0.52, 95% CI 0.34–0.78, p=0.002) was inversely associated with hemorrhage. Conclusion Analysis of venous characteristics of brain AVMs may help determine their prognosis and thereby identify lesions most appropriate for treatment.

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Section: Discussioncontrasting

confidence: 74%

“…Some studies report increased risk of hemorrhage, 8, 13, 18, 19 while other reports suggest no impact 12 or a protective role for ectasia. 11, 20 This study found that venous ectasia is inversely related to intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

Alexander

Cooke

Nelson³

et al. 2015

AJNR Am J Neuroradiol

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“…Annual ICH rates in untreated AVMs range from about 2 to 4% . These rates may vary according to several AVM characteristics, such as location, venous drainage, lesion size, presence of associated aneurysms, or history of previous bleeding . It has long been hypothesized that unruptured and untreated high‐grade AVMs may have a higher risk of subsequent bleeding than those of low‐grade lesions.…”

Section: Introductionmentioning

confidence: 99%

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Stefani

Ribeiro

Mohr

2019

Ann Clin Transl Neurol

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Objective To assess the relationship of the grade of unruptured and untreated Brain Arteriovenous Malformations (AVMs), with the risk of subsequent stroke and death during follow‐up. Methods This prospective study was drawn from a cohort of adult patients with unruptured AVMs, who participated in the conservative treatment arm (medical management only for headache or seizures) of the randomized clinical trial of unruptured brain AVMs (ARUBA study). The grade of AVMs (Spetzler–Martin scale) was dichotomized into categories: AVMs of grades I and II were considered low grade; AVMs of grades III and IV were considered high grade. There were no grade V AVM patients in ARUBA. The primary outcome was symptomatic stroke (hemorrhagic or ischemic – documented by imaging) or death. Results The conservative treatment group had 123 patients (“as treated” analysis). 71 (57.7%) had lesions characterized for this analysis as low‐grade lesions and 52 (42.2%) as high grade. From the total of 10 (8.13%) primary outcomes, three occurred (4.22%) in low‐grade AVMs and seven (13.46%) in high‐grade AVMs (P = 0.0942). Interpretation Statistical analysis of the cohort of patients with unruptured and untreated AVMs from ARUBA study showed that the graduation categories (Spetzler–Martin grades) were not associated with the outcome of subsequent stroke or death.

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“…In addition, other factors that are important for the evaluation of AVMs or deemed as significant determinants of risks and outcomes such as the pattern of supplying artery and draining vein, AVM related aneurysms, presence of arteriovenous fistula (AVF) and detailed hemodynamic information were evaluated 8–10 . These results were then compared with those of DSA and TOF MRA respectively to test whether the information derived from dynamic MRA is consistent with the gold standard of DSA, and whether dynamic MRA will improve the existing diagnosis based on TOF MRA.…”

Section: Introductionmentioning

confidence: 99%

Noncontrast dynamic MRA in intracranial arteriovenous malformation (AVM): comparison with time of flight (TOF) and digital subtraction angiography (DSA)

Yan

Yao

et al. 2012

Magnetic Resonance Imaging

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Purpose Digital subtraction angiography (DSA) remains the gold standard to diagnose intracranial arteriovenous malformations (AVMs) but is invasive. Existing magnetic resonance angiography (MRA) is suboptimal for assessing the hemodynamics of AVMs. The objective of this study was to evaluate the clinical utility of a novel noncontrast four-dimensional (4D) dynamic MRA (dMRA) in the evaluation of intracranial AVMs through comparison with DSA and time-of-flight (TOF) MRA. Materials and methods Nineteen patients (12 women, mean age 26.2±10.7 years) with intracranial AVMs were examined with 4D dMRA, TOF and DSA. Spetzler–Martin grading scale was evaluated using each of the above three methods independently by two raters. Diagnostic confidence scores for three components of AVMs (feeding artery, nidus and draining vein) were also rated. Kendall's coefficient of concordance was calculated to evaluate the reliability between two raters within each modality (dMRA, TOF, TOF plus dMRA). The Wilcoxon signed-rank test was applied to compare the diagnostic confidence scores between each pair of the three modalities Results dMRA was able to detect 16 out of 19 AVMs, and the ratings of AVM size and location matched those of DSA. The diagnostic confidence scores by dMRA were adequate for nidus (3.5/5), moderate for feeding arteries (2.5/5) and poor for draining veins (1.5/5). The hemodynamic information provided by dMRA improved diagnostic confidence scores by TOF MRA. Conclusion As a completely noninvasive method, 4D dMRA offers hemodynamic information with a temporal resolution of 50–100 ms for the evaluation of AVMs and can complement existing methods such as DSA and TOF MRA.

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Cerebral arteriovenous malformations: influence of angioarchitecture on bleeding risk

Cited by 29 publications

References 31 publications

Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Noncontrast dynamic MRA in intracranial arteriovenous malformation (AVM): comparison with time of flight (TOF) and digital subtraction angiography (DSA)

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