Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants.

Abstract

The most serious and frequent complication of intracranial arteriovenous malformations (AVMs) is intracranial hemorrhage. Identification of patients at greatest risk for intracranial bleeding would be beneficial. Detailed analysis of vascular architecture was performed in 65 patients with intracranial AVMs to identify the vascular characteristics that correlated with hemorrhage. Fifteen characteristics were assessed. Hemorrhage was present in 45 patients (69%). The following characteristics correlated positively with hemorrhage (Fisher-Irwin exact test): central venous drainage (P less than .0001), periventricular or intraventricular location of the AVM (P = .0002), and intranidal aneurysm (P = .028). The following characteristics correlated negatively with hemorrhage: angiomatous change (P = .0005), peripheral venous drainage (P = .005), and mixed venous drainage (P = .021). Multivariate linear discriminant analysis demonstrated that central venous drainage, angiomatous change (negatively predictive), intranidal aneurysm, and periventricular or intraventricular location of the AVM were the most discriminating or predictive characteristics of hemorrhage. Detailed analysis of the vascular architecture of intracranial AVMs helped identify features that strongly correlate with clinical hemorrhage and have important prognostic implications for the treatment of patients with these lesions.

Does treatment with N-butyl cyanoacrylate embolization protect against hemorrhage in cerebral arteriovenous malformations?

“…Findings concerning the topography of cAVM indicate that deep lesions are usually associated with presentation with hemorrhage, having a more aggressive clinical course and a tendency towards recurring hemorrhages (recurrence rate may reach 30%) 2,20 . After adjustment for several relevant factors, the association between deep lesion topography and occurrence of subsequent hemorrhage was confirmed (when compared to other locations), although the risk was reduced.…”

“…Associated aneurysms, especially intranidal, are also considered a factor of increased risk for hemorrhage in untreated cAVMs 2,12,27,28 . The occlusion of aneurysms has been thought to confer relative protection 2,12,29 .…”

“…The occlusion of aneurysms has been thought to confer relative protection 2,12,29 . but this was not what we observed in the present study, in which patients presented hemorrhage even after aneurysm occlusion.…”

“…The usual symptoms are hemorrhage (about 50% of the cases), seizures (30%), headaches (20%), progressive neurological deficit (5%), and other less common presentations (5%) 1 . The risk of hemorrhage varies from 2 to 4% per year, and may reach 18% after a first bleeding episode [1][2][3][4] . Hemorrhage is usually associated with 10 to 15% morbidity in cAVM, and this rate increases after each recurrence [4][5][6] .…”

“…The factors that are known to predispose to the occurrence of hemorrhage are smallsized lesions, deep or posterior fossa location, deep venous drainage, venous stenosis, elevated per-fusion pressure, and presence of aneurysms 2,3,[10][11][12][13] . Some investigators claim that presentation with seizures may be a protective factor against hemorrhage in untreated cAVMs.…”