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The clear need for a prospective pediatric arteriovenous malformation trial
  1. David C Lauzier1,
  2. Ananth Vellimana2,
  3. Akash P Kansagra2
  1. 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
  2. 2 Mallinckrodt Institute of Radiology, Department of Neurological Surgery, and Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  1. Correspondence to David C Lauzier, Washington University in St Louis School of Medicine, St Louis, USA; dlauzier{at}

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We read with interest the recent excellent work by Hak and colleagues on the recurrence of pediatric brain arteriovenous malformations (AVM) following successful treatment.1 Their study describes an eye-opening 15% recurrence rate in a retrospectively analyzed cohort of 70 children with AVMs and an 11% recurrence rate in an accompanying meta-analysis. These results are in agreement with the findings of two other studies from the past 18 months that each report a 10.4% recurrence rate, one in a cohort of 67 children2 and another in a cohort of 115 children.3 All three papers established younger age as a risk factor for recurrence. Other factors that may portend a higher risk of recurrence include hemorrhagic presentation and treatment modality.2 3

These authors, and others, have concluded that long-term imaging protocols are necessary for children even after angiographically confirmed AVM cure, and that the …

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  • Contributors All authors have met ICMJE criteria for authorship, and all authors have read and approved the submitted manuscript. Study conception: DCL and APK. APK. Manuscript writing: DCL, AV, and APK. Critical revision: AV, APK. Final approval: DCL, AV, APK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests APK is a consultant for Penumbra and Microvention.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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