Hemorrhage rate in patients with spetzler-martin grades IV and V arteriovenous malformations : Is treatment justified?

• Published in: Stroke (1970) 2007-02, Vol.38 (2), p.325-329
• Main Authors: JAYARAMAN, Mahesh V, MARCELLUS, Mary L, DO, Huy M, CHANG, Steven D, ROSENBERG, Jarrett K, STEINBERG, Gary K, MARKS, Michael P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiovascular system; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - therapy; Child; Diseases of the nervous system; Embolization, Therapeutic - adverse effects; Female; Humans; Intracranial Arteriovenous Malformations - complications; Intracranial Arteriovenous Malformations - epidemiology; Intracranial Arteriovenous Malformations - therapy; Male; Medical sciences; Middle Aged; Neurology; Pharmacology. Drug treatments; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000254497.24545.de

We sought to examine the prospective annual risk of hemorrhage in patients harboring Spetzler-Martin grades IV and V arteriovenous malformations (AVMs) before and after initiation of treatment. Medical records of 61 consecutive patients presenting with Spetzler-Martin grades IV and V AVMs were retrospectively reviewed for demographics, angiographic features, presenting symptom(s), and time of all hemorrhage events, before or after treatment initiation. Pretreatment hemorrhage rates (excluding hemorrhages at presentation) and posttreatment rates were subsequently calculated. Modified Rankin Scale (mRS) scores before and after treatment were recorded. The annual pretreatment hemorrhage rate for all patients was 10.4% per year (95% CI, 2.2 to 15.4%), 13.9% (95% CI, 3.5 to 22.1%) in patients with hemorrhagic presentation and 7.3% (2.6 to 14.3%) in patients with nonhemorrhagic presentation. Posttreatment hemorrhage rates were 6.1% per year (95% CI, 2.5 to 13.2%) for all patients, 5.6% (95% CI, 2.1 to 11.8%) for patients presenting with hemorrhage and 6.4% (95% CI, 1.6 to 10.1%) in patients with nonhemorrhagic presentation. A noninferiority test showed that the posttreatment hemorrhage rate was less than or equal to the pretreatment hemorrhage rate (P