Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations

Abstract

Purpose-The purpose of this study was to define the influence of feeding mean arterial pressure (FMAP) in conjunction with other morphological or clinical risk factors in determining the probability of hemorrhagic presentation in patients with cerebral arteriovenous malformations (AVMs). Methods-Clinical and angiographic data from 340 patients with cerebral AVMs from a prospective database were reviewed. Patients were identified in whom FMAP was measured during superselective angiography. Additional variables analyzed included AVM size, location, nidus border, presence of aneurysms, and arterial supply and venous drainage patterns. The presence of arterial aneurysms was also correlated with site of bleeding on imaging studies. Results-By univariate analysis, exclusively deep venous drainage, periventricular venous drainage, posterior fossa location, and FMAP predicted hemorrhagic presentation. When we used stepwise multiple logistic regression analysis in the cohort that had FMAP measurements (nϭ129), only exclusively deep venous drainage (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.4 to 9.8) and FMAP (OR, 1.4 per 10 mm Hg increase; 95% CI, 1.1 to 1.8) were independent predictors (PϽ0.01) of hemorrhagic presentation; size, location, and the presence of aneurysms were not independent predictors. There was also no association (Pϭ0.23) between the presence of arterial aneurysms and subarachnoid hemorrhage. Conclusions-High arterial input pressure (FMAP) and venous outflow restriction (exclusively deep venous drainage)were the most powerful risk predictors for hemorrhagic AVM presentation. Our findings suggest that high intranidal pressure is more important than factors such as size, location, and the presence of arterial aneurysms in the pathophysiology of AVM hemorrhage.

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

“…All factors that contribute to venous hypertension are likely to increase the potential risk of intracerebral haemorrhage (ICH). The number of draining veins appears to have an inverse relation to venous pressure and thus to haemorrhagic risk [10][11][12]. Venous stenosis is more commonly seen in patients presenting with ICH [13,14].…”

Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx

“…Since the pioneers in the early 1960s reported using methyl methacrylate to embolize the feeding pedicle to treat AVMs, a considerable evolution of microcatheter tools, embolization materials and techniques has proved the success of embolization. Onyx is a new embolization material that has gradually been adopted for AVM embolization during the past decade, and some authors have already reported their initial experiences in the treatment of AVMs with Onyx [11][12][5][6][7][8][9][10][11][12][13][14][15][16]19,21,23,[25][26][27][28] . As mentioned in these articles, Onyx is a nonadhesive agent with controllable endovascular behavior, which allows more precise nidus penetration creating a solid cast, the overall initial complete obliteration rate of intracranial AVMs with Onyx is rela-tively high compared with that of other embolic agents 7,28 .…”

“…But if the AVMs are small or supplied by a small number of branches, we should embolize the AVMS as completely as possible. Duong et Al 6 reported that high arterial input pressure and venous outflow restriction (exclusively deep venous drainage) were the most powerful risk predictors for hemorrhagic AVM presentation.…”

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

“…17 Variants that were reported to be predictive of BAVM rupture but were not expanded in the recommended protocol were defined with reference to previous studies. [18][19][20] BAVM location was dichotomized into deep (basal ganglia, thalamus, cerebellum, and corpus callosum) and superficial (all other locations). A posterior fossa location was defined as brain stem, cerebellum, or both.…”