Purpose Although ruptured intracranial AVMs are responsible for around 2% of cerebral hemorrhages, more than 50% of intracranial AVMs present with hemorrhage which remains the most significant risk factor for re-bleed. However, controversies surround the hemorrhage-related morbidity in patients harboring intracranial arterio-venous malformations (AVMs). In this study, we paralleled the natural history and pre/post treatment outcome measure of patients presenting with ruptured and unruptured AVMs.
Methods This is an ongoing IRB-approved retrospective study. Consecutive adult patients between 2008–2013 presenting with unruptured AVMs and patients presenting with first intracranial AVM hemorrhage incident verified by CT/MR brain imaging were enrolled in the study. Baseline demographics, medical risk factors, baseline NIHSS score, lesion characteristics (maximum nidus diameter, supra vs. infra-tentorial localization, associated aneurysm, superficial and/or deep drainage, or location), discharge NIHSS score, and 90 days mRS score were obtained. Baseline and discharge NIHSS score were categorized into 3 groups as: 0, 1–9, and ≥10 and 90 days mRS 0–2 was defined as long-term good functional outcome. Univariate (independent samples T test, ANOVA, chi square) and logistic regression analyzes were performed to determine the statistical significance. P value of > 0.05 was considered statistically significant.
Results Fifty nine intracranial AVM cases (32F/27M; mean age ± SD: 40.52 ± 14.52) were enrolled to the study. Patients were categorized into ruptured (n = 31) and unruptured (n = 28) groups. The comparative demographic and admission natural history between 2 groups is demonstrated in the Table 1.
Although more patients in ruptured group achieved better discharge NIHSS score compared with unruptured group (3 cases vs.1 case), in ruptured group 7 cases (22%) did not achieve good functional outcome whereas all the patients in unruptured group achieved good functional out come in the follow-up visits. Age, history of smoking, history of hypertension, and presentation with rupture were significantly associated with poor functional outcome (P = 0.017, 0.036, 0.040, 0.007, respectively).
Conclusions According to our patient cohort and preliminary results, ruptured intracranial AVM presentations are highly associated with pre- treatment and long term morbidity in comparison to unruptured AVMs. However, multidisciplinary surgical, endovascular, and radiation therapy is able to achieve a favorable independent outcome in both ruptured and particularly unruptured groups.
Disclosures A. Honarmand: None. F. Syed: None. M. Hurley: None. A. Shaibani: None. S. Ansari: None.
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