Features Predictive of Brain Arteriovenous Malformation Hemorrhage

Abstract

Background and Purpose-Although there is generally thought to be a 2% to 4% per annum rupture risk for brain arteriovenous malformations (bAVMs), there is no way to estimate risk for an individual patient. Methods-In this retrospective study, patients were eligible who had nidiform bAVMs and underwent detailed pretreatment diagnostic cerebral angiography at our medical center from 1996 to 2006. All patients had superselective microcatheter angiography, and films were reviewed for the purpose of this project. Patient demographics, clinical presentation, and angioarchitectural characteristics were analyzed. A univariate analysis was performed, and angioarchitectural features with potential physiological significance that showed at least a trend toward significance were added to a multivariate logistic regression model. Results-One hundred twenty-two bAVMs met criteria for study entry. bAVMs with single venous drainage anatomy were more likely to present with hemorrhage. In addition, patients with multiple draining veins and a venous stenosis reverted to a risk similar to those with 1 draining vein, whereas those with multiple draining veins and without stenosis had diminished association with hemorrhage presentation. Those bAVMs with associated aneurysms were more likely to present with hemorrhage. These findings were robust in both univariate and multivariate models. Conclusions-The

The Effect of Age, Sex, and Lesion Location on Initial Presentation in Patients with Brain Arteriovenous Malformations

“…29 In our series, the mean age of patients with hemorrhage was significantly lower than that of those without hemorrhage ( Figure 2). However, in the study led by Sahlein et al, 30 the hemorrhage group was statistically significantly older than the nonhemorrhage group. In our series, a significantly higher hemorrhage rate (53.2%) occurred in the elderly patients (>60 years) compared with the rate in patients 40e59 years old ( Figure 1).…”

Grades of brain arteriovenous malformations and risk of hemorrhage and death

“…Fok et al., Tong et al . and Sahlein et al . showed that small size was a risk factor for hemorrhagic presentation.…”

Linking Brain Arteriovenous Malformations With Anorectal Hemorrhoids: A Clinical and Anatomical Review

“…). For instance, HHT‐1 exhibits mutations in endoglin (ENG), which codes for an accessory protein of the TGF‐β adaptor complex (Gross et al, ; Goyal et al, ; Sahlein et al, ; Ieva et al, ), whereas HHT‐2 presents with mutations in activin‐like kinase 1 (ALK‐1), which codes for a transmembrane‐bound kinase receptor associated with the transmission signature of TGF‐β (Gross et al, ; Goyal et al, ; Sahlein et al, ; Ieva et al, ). TGF‐β is a cytokine regulating critical developmental milestones such as cell differentiation, migration, adhesion and proliferation.…”