Longitudinal Risk of Intracranial Hemorrhage in Patients With Arteriovenous Malformation of the Brain Within a Defined Population
- 1 July 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 35 (7), 1697-1702
- https://doi.org/10.1161/01.str.0000130988.44824.29
Abstract
Background and Purpose— Accurate estimates for risk and rates of intracranial hemorrhage (ICH) in the natural course of patients harboring brain arteriovenous malformation (BAVM) are needed to provide a quantitative basis for planning clinical trials to evaluate interventional strategies and to help guide practice management. Methods— We identified patients with BAVM at the Kaiser Permanente Northern California health maintenance organization and documented their clinical course. The influences of age at diagnosis, gender, race-ethnicity, ICH at presentation, venous draining pattern, and BAVM size on ICH subsequent to presentation were studied using the multivariate Cox proportional hazards model and Kaplan-Meier curves. Results— We identified 790 patients with BAVM (51% female; 63% white; mean age±SD at diagnosis: 38±19 years) between 1961 and 2001. Patients who presented with ICH experienced a higher rate of subsequent ICH than those who presented without ICH under multivariate analysis (hazard ratio, 3.6; 95% CI, 1.1 to 11.9; P Conclusions— Presentation with ICH was the most important predictor of future ICH, confirming previous studies. Future ICH had similar impact on functional outcome as incident ICH. Intervention to prevent ICH would be of potentially greater benefit to patients presenting with ICH, although the advantage decreases over time.Keywords
This publication has 17 references indexed in Scilit:
- Prospective, Population-Based Detection of Intracranial Vascular Malformations in AdultsStroke, 2003
- Scottish Intracranial Vascular Malformation Study (SIVMS)Stroke, 2003
- Deep arteriovenous malformations of the basal ganglia and thalamus: natural historyJournal of Neurosurgery, 2003
- Observer Agreement in the Angiographic Assessment of Arteriovenous Malformations of the BrainStroke, 2002
- A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adultsBrain, 2001
- Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted County, MinnesotaJournal of Neurosurgery, 1996
- The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessmentJournal of Neurosurgery, 1990
- A proposed grading system for arteriovenous malformationsJournal of Neurosurgery, 1986
- Arteriovenous malformations of the brain: natural history in unoperated patients.Journal of Neurology, Neurosurgery & Psychiatry, 1986
- Bleeding from cerebral arteriovenous malformations as part of their natural historyJournal of Neurosurgery, 1983