Treatment of Unruptured Brain Arteriovenous Malformations: A Single-Center Experience of 86 Patients and a Critique of the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) Trial

Link, Thomas; Winston, Graham; Schwarz, Joshua L.; Lin, Ning; Patsalides, Athos; Gobin, Pierre; Pannullo, Susan C.; Stieg, Philip E.; Knopman, Jared

doi:10.1016/j.wneu.2018.09.025

Cited by 34 publications

(33 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…ARUBA and the Scottish Audit of Intracranial Vascular Malformations prospective, comparative AVM cohort study indicate that patients with unruptured AVMs who received conservative management had better outcomes than those who underwent intervention. 8 12 The present study showed GKS increased haemorrhage risk in unruptured AVM patients above age of 40. Our results seemed to be consistent with the results of ARUBA study.…”

Section: Discussionsupporting

confidence: 57%

“…7 However, the study was limited by a short follow-up period and probable selection bias of participants. 8 The aim of this population-based, case-control study conducted using the Taiwan National Health Insurance Research Database (NHIRD) was to investigate the long-term haemorrhage risk of patients with either ruptured or unruptured AVMs, and the role of gamma knife radiosurgery (GKS) on the risk of bleeding.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

See 1 more Smart Citation

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

et al. 2020

View full text Add to dashboard Cite

ObjectivesThe present nationwide population-based cohort study aims to assess the effectiveness of gamma knife radiosurgery (GKS) on ruptured and unruptured brain arteriovenous malformations (AVMs) by evaluating the haemorrhage rates.DesignA nationwide, retrospective cohort study.SettingTaiwan National Health Insurance Research Database (NHIRD).ParticipantsAn observational study of 1515 patients who were diagnosed with brain AVMs between 1997 and 2013 from the Taiwan NHIRD.Primary outcome and secondary outcome measuresWe performed a survival analysis using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to explore the relationship between treatment modalities (GKS vs non-GKS) and haemorrhage, adjusted for age and sex.ResultsThe GKS and non-GKS groups included 317 and 1198 patients, respectively. Patients in the GKS group (mean±SD, 33.08±15.48 years of age) tended to be younger than those in the non-GKS group (37.40±17.62) (p<0.001). The 15-year follow-up revealed that the rate of bleeding risk was lower in the GKS group than in the non-GKRS group (adjusted HR (aHR) 0.61; 95% CI 0.40 to 0.92). The bleeding risk of ruptured AVMs was significantly lower in GKS group than in the non-GKS group (aHR 0.34; 95% CI 0.19 to 0.62). On the other hand, the bleeding risk of unruptured AVMs was higher in the GKS group than in the non-GKS group (aHR 1.95; 95% CI 1.04 to 3.65). In the unruptured AVM group, the incidence of bleeding was significantly higher among patients in the GKS group that were of >40 years of age (aHR 3.21; 95% CI 1.12 to 9.14).ConclusionsGKS is safe and it reduces the risk of haemorrhage in patients with ruptured AVMs. The administration of GKS to patients with unruptured AVMs who are above the age of 40 years old male might increase the risk of haemorrhage.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In the absence of reliable biomarkers for treatment-related risk stratification of AVMs, endovascular treatment strategies remain controversial. 23,24 Because the neurovasculature consists of many vessels connected in complex and often patientdependent patterns, the connectivity of flow channels is key to understanding the significance of hemodynamic measurements and obtaining such biomarkers. FDNGs provide a standardized format to visualize and quantitatively compare variants in CoW architecture.…”

Section: Discussionmentioning

confidence: 99%

Standardized Evaluation of Cerebral Arteriovenous Malformations Using Flow Distribution Network Graphs and Dual‐venc 4D Flow MRI

Aristova

Vali

Ansari

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background Cerebral arteriovenous malformations (AVMs) are pathological connections between arteries and veins. Dual‐venc 4D flow MRI, an extended 4D flow MRI method with improved velocity dynamic range, provides time‐resolved 3D cerebral hemodynamics. Purpose To optimize dual‐venc 4D flow imaging parameters for AVM; to assess the relationship between spatial resolution, acceleration, and flow quantification accuracy; and to introduce and apply the flow distribution network graph (FDNG) paradigm for storing and analyzing complex neurovascular 4D flow data. Study Type Retrospective cohort study. Subjects/Phantom Scans were performed in a specialized flow phantom: 26 healthy subjects (age 41 ± 17 years) and five AVM patients (age 27–68 years). Field Strength/Sequence Dual‐venc 4D flow with varying spatial resolution and acceleration factors were performed at 3T field strength. Assessment Quantification accuracy was assessed in vitro by direct comparison to measured flow. FDNGs were used to quantify and compare flow, peak velocity (PV), and pulsatility index (PI) between healthy controls with various Circle of Willis (CoW) anatomy and AVM patients. Statistical Tests In vitro measurements were compared to ground truth with Student's t‐test. In vivo groups were compared with Wilcoxon rank‐sum test and Kruskal–Wallis test. Results Flow was overestimated in all in vitro experiments, by an average 7.1 ± 1.4% for all measurement conditions. Error in flow measurement was significantly correlated with number of voxels across the channel (P = 3.11 × 10−28) but not with acceleration factor (P = 0.74). For the venous‐arterial PV and PI ratios, a significant difference was found between AVM nidal and extranidal circulation (P = 0.008 and 0.05, respectively), and between AVM nidal and healthy control circulation (P = 0.005 and 0.003, respectively). Data Conclusion Dual‐venc 4D flow MRI and standardized FDNG analysis might be feasible in clinical applications. Venous‐arterial ratios of PV and PI are proposed as network‐based biomarkers characterizing AVM nidal hemodynamics. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1718–1730.

show abstract

“…One of these patients presented an intraoperative rupture. Since ARUBA recommended conservative treatment in this group of patients, multiple studies reported lower morbidity and mortality rates after treatment of unruptured AVMs (surgery, embolization, and radiosurgery) following the publication of ARUBA [32]. Based on this, the rational for the treatment of our patients with unruptured AVMs was the good outcomes obtained after treatment and the potential risk of future hemorrhage since this is a pediatric population.…”

Section: Discussionmentioning

confidence: 94%

Early Outcomes and Complications of Endovascular Treatment of Cerebral Arteriovenous Malformations in Pediatric Patients

et al. 2021

View full text Add to dashboard Cite

Introduction: Arteriovenous malformations (AVMs) are the commonest cause of hemorrhagic stroke in children. Endovascular embolization is a feasible treatment modality, but cure rates are heterogenous from one series to another. We aimed to describe the immediate obliteration rates and periprocedural complications of embolization of pediatric AVMs. Methods: Between 2011 and 2019, participants below 18 years of age with AVMs treated by the same neurosurgeon at a single center were included. The clinical features, immediate angiographic results, and periprocedural complications were retrospectively collected from the clinical records. Results: Thirty-four embolization sessions were performed on 20 children (12 females with a mean age of 13). Intracranial hemorrhage was the most common presentation (75%), and the majority were frontal (30%) and basal ganglia (30%) lesions. An immediate complete angiographic obliteration was achieved in 9 patients (45%) with low-grade lesions (Spetzler-Martin grade I and II). NBCA was the most common embolic agent used (52.9%). Complications were reported in 3 (8.8%) out of 34 sessions. Two of them were intraoperative perforations with clinical consequences. A slight cortical hemorrhage during the procedure was observed in 1 patient without clinical repercussions. Discussion: This single-surgeon single-center experience suggests that endovascular treatment is a safe and efficient treatment for pediatric AVMs. Pediatric prognostic scores for a suitable selection of candidates are needed. Further studies are required to validate these results.

show abstract

Treatment of Unruptured Brain Arteriovenous Malformations: A Single-Center Experience of 86 Patients and a Critique of the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) Trial

Cited by 34 publications

References 23 publications

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

Standardized Evaluation of Cerebral Arteriovenous Malformations Using Flow Distribution Network Graphs and Dual‐venc 4D Flow MRI

Early Outcomes and Complications of Endovascular Treatment of Cerebral Arteriovenous Malformations in Pediatric Patients

Contact Info

Product

Resources

About