Photo Credit: Mr. Suphachai Praserdumrongchai
The following is a summary of “Risk of intracranial hemorrhage in brain arteriovenous malformations: a systematic review and meta-analysis,” published in the February 2024 issue of Neurology by Liyis et al.
Researchers conducted a retrospective study to identify factors linked to future bleeding events in patients with brain arteriovenous malformations (bAVMs).
They conducted systematic searches on ScienceDirect, Medline, and Cochrane databases. Risk factors such as bAVM size, bAVM volume, hemorrhage and seizure occurrences, presence of deep venous drainage, deep-seated bAVMs, associated aneurysms, and Spetzler–Martin grade were evaluated. Subgroup analyses were performed on previous treatments, hemorrhage occurrence, AVM size, and management type.
The results showed 8 cohort studies and 2 trials involving 4,240 participants. Initial hemorrhage presentation (HR 2.41; 95% CI 1.94–2.98; P<0.001), any deep venous drainage (HR 1.52; 95% CI 1.09–2.13; P=0.01), and associated aneurysms (HR 1.78; 95% CI 1.41–2.23; P<0.001) increased secondary hemorrhage risk. Higher Spetzler–Martin grades (HR 0.77; 95% CI 0.68–0.87; P<0.001) and larger malformation volumes (HR 0.87; 95% CI 0.76–0.99; P=0.04) reduced risk. Subgroups showed any deep venous drainage in patients without prior treatment (HR 1.64; 95% CI 1.25–2.15; P<0.001), bAVM > 3 cm (HR 1.79; 95% CI 1.15–2.78; P=0.01), and multimodal interventions (HR 1.69; 95% CI 1.12–2.53; P=0.01) increased risk. A reverse effect was found for patients initially presented without hemorrhage (HR 0.79; 95% CI 0.67–0.93; P=0.01). Deep bAVM was a risk factor in > 3 cm cases (HR 2.72; 95% CI 1.61–4.59; P<0.001) and multimodal management (HR 2.77; 95% CI 1.66–4.56; P<0.001). Kaplan–Meier analysis showed a higher hemorrhage risk for initial bleeding, but intervention patients had better survival rates over 72 months.
They concluded that prior hemorrhage, deep venous drainage, and aneurysms predicted bAVM bleeding, with deep location and multimodality further influencing risk in specific cases.
Source: link.springer.com/article/10.1007/s00415-024-12235-1