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  • Presence of an Aneurysm Serves as a Predictor of Hemorrhagic Presentation in Patients with Cerebral AVMs

    Final Number:

    Thana N. Theofanis MD; Brendan Judy; Nohra Chalouhi MD; Pascal Jabbour MD; Robert H. Rosenwasser MD, FACS, FAHA; Stavropoula I. Tjoumakaris MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Cerebral AVMs are found in 0.1% of the population. When they occur, they are often found in young, healthy individuals, and hemorrhage can be a source of unnecessary morbidity and mortality in these otherwise healthy patients. Identifying risk factors of hemorrhage could help guide decisions to treat AVMs.

    Methods: A retrospective review of all patients treated for AVMs at the Jefferson Hospital for Neuroscience between 1994 and 2010. Data were collected on patient co-morbidities, presence of aneurysm, characteristics of the aneurysm, Spetzler-Martin (SM) Grade of the AVM, clinical presentation, treatment(s) received, therapeutic and clinical outcomes, as well as any complications.

    Results: Of 774 AVM patients treated at the Jefferson Hospital for Neuroscience from 1994-2010, 7.5% (N=61) of the patients were found to have angiographically documented aneurysms. According to the Redekopp et al., classification: 16.4% (N=10) of the aneurysms were intranidal, 52.5% (N=32) were flow related, and 31.1% (N=19) were flow unrelated. According to the Cunha et al., classification 23% (N=14) aneurysms were Grade I, 4.9% (N=3) were Grade Ia, 19.7% (N=12) were Grade II, 21.3% (N=13) were Grade III, 31.1% (N=19) were Grade IV. Predictors of AVM hemorrhagic presentation in univariate analysis (p<0.20) include: presence of an aneurysm, age > 65, increasing number of aneurysms, hypertension, Redekop Grade 2 aneurysm, and Cunha Classification I, II, or III aneurysm.

    Conclusions: The outcomes of AVM patients who present with a hemorrhage can be devastating. In patients with concurrent vascular pathologies, such as an AVM and aneurysm(s), referral to a high-volume neurovascular treatment center for treatment should be strongly considered, as these patients are at a higher risk of experiencing hemorrhagic presentation.

    Patient Care: Identifying risk factors of hemorrhage could help guide decisions to treat AVMs.

    Learning Objectives: 1. Understand the natural history of patient's with AVMs, as well as AVM and aneurysms 2. Identify risk factors for hemorrhage in patients with AVMs


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