Angiographic factors leading to hemorrhage in AVMs: A systematic review and meta-analysis

• Published in: Neurosurgical review 2023-03, Vol.46 (1), p.72-72, Article 72
• Main Authors: Koester, Stefan W., Batista, Savio, Bertani, Raphael, Yengo-Kahn, Aaron, Roth, Steven, Chitale, Rohan, Dewan, Michael
• Format: Article
• Language: English
• Subjects: Cerebral Angiography; Hemorrhage; Humans; Intracranial Arteriovenous Malformations - complications; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - surgery; Medicine; Medicine & Public Health; Neurosurgery; Retrospective Studies; Review; Risk Factors
• ISSN: 1437-2320; 1437-2320
• DOI: 10.1007/s10143-023-01971-z

For patients with unruptured intracranial arteriovenous malformations (AVMs), the risk of a hemorrhagic event is approximately 2% to 4% annually. These events have an associated 20—50% morbidity and 10% mortality rate. An understanding of risk factors that predispose these lesions to rupture is important for optimal management. We aimed to pool a large cohort of both ruptured and unruptured AVMs from the literature with the goal of identifying angiographic risk factors that contribute to rupture. A systematic review of the literature was conducted in accordance with the PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science databases. Studies that presented patient-level data from ruptured AVMs from January 1990 to January 2022 were considered for inclusion. The initial screening of 8,304 papers resulted in a quantitative analysis of 25 papers, which identified six angiographic risk factors for AVM rupture. Characteristics that significantly increase the odds of rupture include the presence of aneurysm (OR = 1.45 [1.19, 1.77], p