Risk factors for hemorrhage of brain arteriovenous malformation

Shaligram, Sonali; Winkler, Ethan A.; Cooke, Daniel L; Su, Hua

doi:10.1111/cns.13200

Cited by 58 publications

(50 citation statements)

References 154 publications

(300 reference statements)

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“…These deficiencies make ARUBA's findings cannot be recognized as the first-line evidence to select conservative management or intervention of all unruptured bAVMs. Previous studies proposed that elevations of vascular endothelial growth factor (VEGF) or alterations in the vascular wall [10] and many hemodynamic changes, such as flow-related aneurysms [11], abnormally high blood flow through shunting [12], smaller bAVMs, a single and/or stenosed draining vein, and so on [13], may contribute to bAVMs rupture. In this study, the hemorrhagic hemodynamic factors were similar to previous studies, which means that most of the participants in mainland China share the same view on the hemorrhagic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen

Meng

et al. 2020

Chin Neurosurg Jl

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Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China. Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. Forty-two (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (< 30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P < 0.01) and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs, and more exploration of individualized intraoperative management was necessary.

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Section: Discussionmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen

Meng

et al. 2020

Chin Neurosurg Jl

View full text Add to dashboard Cite

show abstract

“…These deficiencies make ARUBA's findings can't be recognized as the first-line evidence to select conservative management or intervention of all unruptured bAVMs. Previous studies proposed that elevations of vascular endothelial growth factor (VEGF) or alterations in the vascular wall (10), and many hemodynamic changes, such as flow-related aneurysms (11), abnormally high blood flow through shunting (12), smaller bAVMs, a single and/or stenosed draining vein and so on (13), may contribute to bAVMs rupture. In this study, the hemorrhagic hemodynamic factors were similar to previous studies, which means that most of the participants in mainland China share the same view on the hemorrhagic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen¹,

Meng²,

Li³

et al. 2020

Preprint

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Background:In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods:We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results:A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions:Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.

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“…These de ciencies make ARUBA's ndings can't be recognized as the rst-line evidence to select conservative management or intervention of all unruptured bAVMs. Previous studies proposed that elevations of vascular endothelial growth factor (VEGF) or alterations in the vascular wall (10), and many hemodynamic changes, such as ow-related aneurysms (11), abnormally high blood ow through shunting (12), smaller bAVMs, a single and/or stenosed draining vein and so on (13), may contribute to bAVMs rupture. In this study, the hemorrhagic hemodynamic factors were similar to previous studies, which means that most of the participants in mainland China share the same view on the hemorrhagic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen¹,

Meng²,

Li³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.Trial registration: ClinicalTrials.gov NCT04136860.

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Risk factors for hemorrhage of brain arteriovenous malformation

Cited by 58 publications

References 154 publications

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

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