Untreated brain arteriovenous malformation

被引:241
作者
Kim, Helen [1 ,2 ]
Salman, Rustam Al-Shahi [5 ]
McCulloch, Charles E. [2 ]
Stapf, Christian [6 ]
Young, William L. [1 ,3 ,4 ]
机构
[1] Univ Calif San Francisco, Cerebrovasc Res Ctr, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA
[4] Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA
[5] Univ Edinburgh, Ctr Clin Brain Sci, Div Clin Neurosci, Edinburgh EH8 9YL, Midlothian, Scotland
[6] Univ Paris Diderot, Sorbonne Paris Cite, Neurovasc Paris Sorbonne, Paris, France
关键词
INTRACRANIAL VASCULAR MALFORMATION; LONGITUDINAL RISK; NATURAL-HISTORY; HEMORRHAGE;
D O I
10.1212/WNL.0000000000000688
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To identify risk factors for intracranial hemorrhage in the natural history course of brain arteriovenous malformations (AVMs) using individual patient data meta-analysis of 4 existing cohorts. Methods: We harmonized data from Kaiser Permanente of Northern California (n = 856), University of California San Francisco (n = 787), Columbia University (n = 672), and the Scottish Intracranial Vascular Malformation Study (n = 210). We censored patients at first treatment, death, last visit, or 10-year follow-up, and performed stratified Cox regression analysis of time-to- hemorrhage after evaluating hemorrhagic presentation, sex, age at diagnosis, deep venous drainage, and AVM size as predictors. Multiple imputation was performed to assess impact of missing data. Results: A total of 141 hemorrhage events occurred during 6,074 patient-years of follow-up (annual rate of 2.3%, 95% confidence interval [CI] 2.0%-2.7%), higher for ruptured (4.8%, 3.9%-5.9%) than unruptured (1.3%, 1.0%-1.7%) AVMs at presentation. Hemorrhagic presentation (hazard ratio 3.86, 95% CI 2.42-6.14) and increasing age (1.34 per decade, 1.17-1.53) independently predicted hemorrhage and remained significant predictors in the imputed dataset. Female sex (1.49, 95% CI 0.96-2.30) and exclusively deep venous drainage (1.60, 0.95-2.68, p = 0.02 in imputed dataset) may be additional predictors. AVM size was not associated with intracerebral hemorrhage in multivariable models (p>0.5). Conclusion: This large, individual patient data meta-analysis identified hemorrhagic presentation and increasing age as independent predictors of hemorrhage during follow-up. Additional AVM cohort data may further improve precision of estimates, identify new risk factors, and allow validation of prediction models.
引用
收藏
页码:590 / 597
页数:8
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