Comparison of hemorrhagic risk in intracranial arteriovenous malformations between conservative management and embolization as the single treatment modality

Wuyang Yang, Jose L. Porras, Risheng Xu, Maria Braileanu, Syed Khalid, Alice L. Hung, Justin Caplan, Tomas Garzon-Muvdi, Xiaoming Rong, Geoffrey P. Colby, Alexander Coon, Rafael J Tamargo, Judy Huang

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Embolization has been discussed as a feasible single modality treatment for intracranial arteriovenous malformations (AVMs). OBJECTIVE: To compare hemorrhagic risk between embolization and conservative management in a multivariate survival analysis. METHODS: We retrospectively reviewed records of patients with intracranial AVMs evaluated at our institution from 1990 to 2013. We included patients recommended to undergo embolization without other treatment modalities and patientsmanaged conservatively. Multivariate Cox regression analysis of hemorrhage-free survival was performed, with the survival interval right-censored to date of either last follow-up or salvage treatment. RESULTS: We identified 205 patients matching our inclusion criteria, with 160 patients in the noninterventional group and 45 in the embolization group. The average age of all patients was 40.2 ± 19.5 yr, with younger patients undergoing embolization more often (P=.026). Fifty-one (31.9%) conservativelymanaged patients and 13 (28.9%) patients treated by embolization (P = .703) presented with hemorrhage. Other baseline characteristics were similar between the 2 management groups. During an average follow-up period of 7.7 yr, 30 patients (14.6%) experienced hemorrhage recurrence. Multivariate Cox regression revealed older age (P = .031) and hemorrhagic presentation (P < .001) to be statistically associated with follow-up hemorrhage. In a subset analysis of unruptured AVMs, embolization was associated with a 4-fold hazard ratio of hemorrhage compared to conservative management (P = .044). CONCLUSION: Older age and initial presentation with hemorrhage were associated with increased risk of hemorrhage during follow-up. Treatment of AVMs with embolization as the sole modality may increase hemorrhagic risk compared with conservative management, especially in unruptured AVMs.

Original languageEnglish (US)
Pages (from-to)481-490
Number of pages10
JournalClinical Neurosurgery
Volume82
Issue number4
DOIs
StatePublished - Apr 1 2018

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Intracranial Arteriovenous Malformations
Hemorrhage
Arteriovenous Malformations
Therapeutics
Conservative Treatment
Salvage Therapy
Survival
Survival Analysis
Multivariate Analysis
Regression Analysis
Recurrence

Keywords

  • Arteriovenous malformations
  • Conservative management
  • Embolization
  • Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Comparison of hemorrhagic risk in intracranial arteriovenous malformations between conservative management and embolization as the single treatment modality. / Yang, Wuyang; Porras, Jose L.; Xu, Risheng; Braileanu, Maria; Khalid, Syed; Hung, Alice L.; Caplan, Justin; Garzon-Muvdi, Tomas; Rong, Xiaoming; Colby, Geoffrey P.; Coon, Alexander; Tamargo, Rafael J; Huang, Judy.

In: Clinical Neurosurgery, Vol. 82, No. 4, 01.04.2018, p. 481-490.

Research output: Contribution to journalArticle

Yang, Wuyang ; Porras, Jose L. ; Xu, Risheng ; Braileanu, Maria ; Khalid, Syed ; Hung, Alice L. ; Caplan, Justin ; Garzon-Muvdi, Tomas ; Rong, Xiaoming ; Colby, Geoffrey P. ; Coon, Alexander ; Tamargo, Rafael J ; Huang, Judy. / Comparison of hemorrhagic risk in intracranial arteriovenous malformations between conservative management and embolization as the single treatment modality. In: Clinical Neurosurgery. 2018 ; Vol. 82, No. 4. pp. 481-490.
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abstract = "BACKGROUND: Embolization has been discussed as a feasible single modality treatment for intracranial arteriovenous malformations (AVMs). OBJECTIVE: To compare hemorrhagic risk between embolization and conservative management in a multivariate survival analysis. METHODS: We retrospectively reviewed records of patients with intracranial AVMs evaluated at our institution from 1990 to 2013. We included patients recommended to undergo embolization without other treatment modalities and patientsmanaged conservatively. Multivariate Cox regression analysis of hemorrhage-free survival was performed, with the survival interval right-censored to date of either last follow-up or salvage treatment. RESULTS: We identified 205 patients matching our inclusion criteria, with 160 patients in the noninterventional group and 45 in the embolization group. The average age of all patients was 40.2 ± 19.5 yr, with younger patients undergoing embolization more often (P=.026). Fifty-one (31.9{\%}) conservativelymanaged patients and 13 (28.9{\%}) patients treated by embolization (P = .703) presented with hemorrhage. Other baseline characteristics were similar between the 2 management groups. During an average follow-up period of 7.7 yr, 30 patients (14.6{\%}) experienced hemorrhage recurrence. Multivariate Cox regression revealed older age (P = .031) and hemorrhagic presentation (P < .001) to be statistically associated with follow-up hemorrhage. In a subset analysis of unruptured AVMs, embolization was associated with a 4-fold hazard ratio of hemorrhage compared to conservative management (P = .044). CONCLUSION: Older age and initial presentation with hemorrhage were associated with increased risk of hemorrhage during follow-up. Treatment of AVMs with embolization as the sole modality may increase hemorrhagic risk compared with conservative management, especially in unruptured AVMs.",
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T1 - Comparison of hemorrhagic risk in intracranial arteriovenous malformations between conservative management and embolization as the single treatment modality

AU - Yang, Wuyang

AU - Porras, Jose L.

AU - Xu, Risheng

AU - Braileanu, Maria

AU - Khalid, Syed

AU - Hung, Alice L.

AU - Caplan, Justin

AU - Garzon-Muvdi, Tomas

AU - Rong, Xiaoming

AU - Colby, Geoffrey P.

AU - Coon, Alexander

AU - Tamargo, Rafael J

AU - Huang, Judy

PY - 2018/4/1

Y1 - 2018/4/1

N2 - BACKGROUND: Embolization has been discussed as a feasible single modality treatment for intracranial arteriovenous malformations (AVMs). OBJECTIVE: To compare hemorrhagic risk between embolization and conservative management in a multivariate survival analysis. METHODS: We retrospectively reviewed records of patients with intracranial AVMs evaluated at our institution from 1990 to 2013. We included patients recommended to undergo embolization without other treatment modalities and patientsmanaged conservatively. Multivariate Cox regression analysis of hemorrhage-free survival was performed, with the survival interval right-censored to date of either last follow-up or salvage treatment. RESULTS: We identified 205 patients matching our inclusion criteria, with 160 patients in the noninterventional group and 45 in the embolization group. The average age of all patients was 40.2 ± 19.5 yr, with younger patients undergoing embolization more often (P=.026). Fifty-one (31.9%) conservativelymanaged patients and 13 (28.9%) patients treated by embolization (P = .703) presented with hemorrhage. Other baseline characteristics were similar between the 2 management groups. During an average follow-up period of 7.7 yr, 30 patients (14.6%) experienced hemorrhage recurrence. Multivariate Cox regression revealed older age (P = .031) and hemorrhagic presentation (P < .001) to be statistically associated with follow-up hemorrhage. In a subset analysis of unruptured AVMs, embolization was associated with a 4-fold hazard ratio of hemorrhage compared to conservative management (P = .044). CONCLUSION: Older age and initial presentation with hemorrhage were associated with increased risk of hemorrhage during follow-up. Treatment of AVMs with embolization as the sole modality may increase hemorrhagic risk compared with conservative management, especially in unruptured AVMs.

AB - BACKGROUND: Embolization has been discussed as a feasible single modality treatment for intracranial arteriovenous malformations (AVMs). OBJECTIVE: To compare hemorrhagic risk between embolization and conservative management in a multivariate survival analysis. METHODS: We retrospectively reviewed records of patients with intracranial AVMs evaluated at our institution from 1990 to 2013. We included patients recommended to undergo embolization without other treatment modalities and patientsmanaged conservatively. Multivariate Cox regression analysis of hemorrhage-free survival was performed, with the survival interval right-censored to date of either last follow-up or salvage treatment. RESULTS: We identified 205 patients matching our inclusion criteria, with 160 patients in the noninterventional group and 45 in the embolization group. The average age of all patients was 40.2 ± 19.5 yr, with younger patients undergoing embolization more often (P=.026). Fifty-one (31.9%) conservativelymanaged patients and 13 (28.9%) patients treated by embolization (P = .703) presented with hemorrhage. Other baseline characteristics were similar between the 2 management groups. During an average follow-up period of 7.7 yr, 30 patients (14.6%) experienced hemorrhage recurrence. Multivariate Cox regression revealed older age (P = .031) and hemorrhagic presentation (P < .001) to be statistically associated with follow-up hemorrhage. In a subset analysis of unruptured AVMs, embolization was associated with a 4-fold hazard ratio of hemorrhage compared to conservative management (P = .044). CONCLUSION: Older age and initial presentation with hemorrhage were associated with increased risk of hemorrhage during follow-up. Treatment of AVMs with embolization as the sole modality may increase hemorrhagic risk compared with conservative management, especially in unruptured AVMs.

KW - Arteriovenous malformations

KW - Conservative management

KW - Embolization

KW - Hemorrhage

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