The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations

Alice L. Hung, Wuyang Yang, Bowen Jiang, Tomas Garzon-Muvdi, Justin M. Caplan, Geoffrey P. Colby, Alexander L. Coon, Rafael J. Tamargo, Judy Huang

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM. OBJECTIVE: To characterize this hemorrhage risk using our institutional experience over 25 yr. METHODS: We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test. RESULTS: Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older (P =. 005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres (P =. 023 and. 001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage (P <. 001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found (P >. 356). The majority of aneurysms were untreated (69.5%), and only 8 (9.8%) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures (P =. 004). The annual risk of AVM hemorrhage was 1.33% and 1.05% for AVM only patients and AVM-FA patients, respectively (P =. 248). CONCLUSION: Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.

Original languageEnglish (US)
Pages (from-to)466-475
Number of pages10
JournalClinical Neurosurgery
Volume85
Issue number4
DOIs
StatePublished - Oct 1 2019

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Intracranial Arteriovenous Malformations
Arteriovenous Malformations
Aneurysm
Hemorrhage
Subarachnoid Hemorrhage
Rupture
Seizures

Keywords

  • Aneurysm
  • Arteriovenous malformation
  • Feeding artery
  • Hemorrhage risk

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations. / Hung, Alice L.; Yang, Wuyang; Jiang, Bowen; Garzon-Muvdi, Tomas; Caplan, Justin M.; Colby, Geoffrey P.; Coon, Alexander L.; Tamargo, Rafael J.; Huang, Judy.

In: Clinical Neurosurgery, Vol. 85, No. 4, 01.10.2019, p. 466-475.

Research output: Contribution to journalArticle

Hung, Alice L. ; Yang, Wuyang ; Jiang, Bowen ; Garzon-Muvdi, Tomas ; Caplan, Justin M. ; Colby, Geoffrey P. ; Coon, Alexander L. ; Tamargo, Rafael J. ; Huang, Judy. / The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 4. pp. 466-475.
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abstract = "BACKGROUND: Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM. OBJECTIVE: To characterize this hemorrhage risk using our institutional experience over 25 yr. METHODS: We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test. RESULTS: Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older (P =. 005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres (P =. 023 and. 001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage (P <. 001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found (P >. 356). The majority of aneurysms were untreated (69.5{\%}), and only 8 (9.8{\%}) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures (P =. 004). The annual risk of AVM hemorrhage was 1.33{\%} and 1.05{\%} for AVM only patients and AVM-FA patients, respectively (P =. 248). CONCLUSION: Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.",
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T1 - The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations

AU - Hung, Alice L.

AU - Yang, Wuyang

AU - Jiang, Bowen

AU - Garzon-Muvdi, Tomas

AU - Caplan, Justin M.

AU - Colby, Geoffrey P.

AU - Coon, Alexander L.

AU - Tamargo, Rafael J.

AU - Huang, Judy

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N2 - BACKGROUND: Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM. OBJECTIVE: To characterize this hemorrhage risk using our institutional experience over 25 yr. METHODS: We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test. RESULTS: Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older (P =. 005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres (P =. 023 and. 001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage (P <. 001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found (P >. 356). The majority of aneurysms were untreated (69.5%), and only 8 (9.8%) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures (P =. 004). The annual risk of AVM hemorrhage was 1.33% and 1.05% for AVM only patients and AVM-FA patients, respectively (P =. 248). CONCLUSION: Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.

AB - BACKGROUND: Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM. OBJECTIVE: To characterize this hemorrhage risk using our institutional experience over 25 yr. METHODS: We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test. RESULTS: Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older (P =. 005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres (P =. 023 and. 001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage (P <. 001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found (P >. 356). The majority of aneurysms were untreated (69.5%), and only 8 (9.8%) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures (P =. 004). The annual risk of AVM hemorrhage was 1.33% and 1.05% for AVM only patients and AVM-FA patients, respectively (P =. 248). CONCLUSION: Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.

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KW - Arteriovenous malformation

KW - Feeding artery

KW - Hemorrhage risk

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