Angioarchitectural Risk Factors For Rupture Hemorrhage Induced By Cerebral Arteriovenous Malformations

Objective: To explore the potential angioarchitectural risk factors for intracranial hemorrhage induced by cerebral arteriovenous malformations,in an attempt to provide evidence for clinical diagnosis and treatment.Methods: Clinical and imaging data was collected from 88 patients with cerebral arteriovenous malformations(CAVM)admitted to Second Hospital of Dalian Medical University from January 2001 to December 2015.Among the 88 patients,45 were males and 43 were females;the median age was 40.5 years(range 15-80 years);the disease course was 2 hours to 40 years,with the mean 31.6 months.All the patients had been confirmed with CAVM by digital subtraction angiography(DSA),and had been documented by head CT;some of them had underwent CT,MRI or MRA.The observational indicators included location and size of the CAVM lesion,number and diameter of feeding arteries,and number of draining veins and drainage method.χ~2test and multivariate regression analysis were used.Univariate ANOVA was performed for each observational indicator as the independent factor before multivariate Logistic regression analysis,so as to explore the angioarchitectural risk factors for rupture hemorrhage induced by CAVM.Results: 48(54.5%)of the 88 patients experienced rupture hemorrhage.Statistical analysis using χ~2 test indicated higher risk of cerebral hemorrhage in the presence of the following angioarchitectural risk factors: 20 of the 24 patients(83.3%)with micro or small CAVM lesion sized≤2cm experienced hemorrhage,P<0.05;23 of the 33 patients(69.7%)with ≤2 feeding arteries experienced hemorrhage,P<0.05;17 of the 19 patients (89.5%)with feeding artery diameter 0.5-1.0mm experienced hemorrhage,P<0.005;42 of the 64 patients(65.6%)with ≤2 draining veins experienced hemorrhage,P<0.005;10 of the 12 patients(83.3%)simply receiving deep vein drainage experienced hemorrhage,P<0.05.In comparison,location of CAVM lesion,cerebral draining venous dilation,cerebral draining venous stenosis and the presence of aneurysm showed no significant correlation with cerebral hemorrhage: 5 of the 6 patients(83.3%)with the infratentorial CAVM lesion experienced hemorrhage,P>0.05;9 of the 20 patients(45.0%)receiving draining venous dilation experienced hemorrhage,P>0.05;10 of the 17 patients(58.8%)with draining venous stenosis experienced hemorrhage,P>0.05;5 of the 6 patients(83.3%)with aneurysm experienced hemorrhage,P>0.05.Multivariate regression analysis further suggested that AVM size,number of feeding arteries,diameter of feeding arteries,and number of draining veins had significant effect on hemorrhage;venous drainage method had certain effect on hemorrhage;while CAVM location,presence of aneurysm,venous dilation and venous stenosis had no significant effect on hemorrhage.Conclusion: The risk of hemorrhage associated with CAVM is correlated with size of AVM lesion,number and diameter of feeding arteries,and number of draining veins;possibly correlated with the drainage method;and not significantly correlated with CAVM location,venous dilation,venous stenosis,or presence of aneurysm.Specifically,there would be higher risk of CAVM rupture hemorrhage in the presence of AVM lesion size ≤2cm,≤2 feeding arteries,feeding artery diameter ≤1mm,≤2 draining veins and/or simple deep vein drainage being the drainage method.