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The pandemic and neurointervention
Impact of COVID-19 pandemic on treatment and outcomes of cerebral arteriovenous malformations
  1. Ian A Ramsay1,
  2. Vaidya Govindarajan2,
  3. Turki Elarjani2,
  4. Ahmed Abdelsalam2,
  5. Michael Silva2,
  6. Robert M Starke2,
  7. Evan Luther2
  1. 1 University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Ian A Ramsay, University of Miami Miller School of Medicine, Miami, FL 33136, USA; ian.ramsay{at}med.miami.edu

Abstract

Background There has been a recent decrease in interventional management of cerebral arteriovenous malformations (AVMs). The objective of our study was to evaluate the changing patterns in management of AVMs in the first year of the COVID-19 pandemic.

Methods The National Inpatient Sample (NIS) database was used. From 2016 to 2020, patients with an International Classification of Diseases, 10th revision (ICD-10) diagnosis code for a cerebral AVM were included. An intervention was defined as ICD-10 code for surgical, endovascular, or stereotactic radiosurgery treatment. Odds ratios (ORs) were calculated using a logistic regression model with covariates deemed to be clinically relevant.

Results 63 610 patients with AVMs were identified between 2016 and 2020, 14 340 of which were ruptured. In 2020, patients had an OR of 0.69 for intervention of an unruptured AVM (P<0.0001) compared with 2016–19. The rate of intervention for unruptured AVMs decreased to 13.5% in 2020 from 17.6% in 2016–19 (P<0.0001). The rate of AVM rupture in 2020 increased to 23.9% from 22.2% in 2016–19 (P<0.0001). In 2020, patients with ruptured AVMs had an OR for inpatient mortality of 1.72 compared with 2016–19. Linear regression analysis from 2016 to 2020 showed an inverse relationship between intervention rate and rupture rate (slope −0.499, R2=0.88, P=0.019).

Conclusion In 2020, the rate of intervention for unruptured cerebral AVMs decreased compared with past years, with an associated increase in the rate of rupture. Patients with ruptured AVMs also had a higher odds of mortality.

  • Arteriovenous Malformation
  • COVID-19
  • Hemorrhage
  • Subarachnoid
  • Stroke

Data availability statement

Data are available in a public, open access repository. The authors had full access to the data. All data are available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.

https://doi.org/10.1136/jnis-2023-020735

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    Data availability statement

    Data are available in a public, open access repository. The authors had full access to the data. All data are available from the Healthcare Cost and Utilization Project as part of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.

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    Footnotes

    • Twitter @AbdelsalamMd, @Starke_neurosurgery

    • Contributors All authors significantly contributed to this manuscript. Concept and design: RMS, AA, EL, IR, and MS. Data acquisition: EL, VG, and IR. Data analysis and interpretation: RMS, EL, IR, and VG. Literature search: IR, TE, and VG. Drafting the first manuscript: IR, EL, and VG. Revision of the manuscript for important intellectual content: IR, TE, EL, RMS, MS, and AA. Guarantor of study: IAR. Approval of final manuscript version for submission: all authors.

    • Funding RMS’s research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by the National Institutes of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS also has an unrestricted research grant from Medtronic.

    • Competing interests The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. RMS has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus.

    • Provenance and peer review Not commissioned; externally 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.