Clinical Appfied Study Of The Predictive Value Of DSA On Cerebral Arteriovenousmalformation Bleeding

Section oneClinical data and angioarehiteetural analysis of 199 patients with brain arteriovenous malformationsObjectiveThe purpose of this part was to assess the demographic distribution and clinical and morphological characteristics of this group of patients with brain AVMs, to defme each brain AVM angioarchitectural feature in this study and to summarize and classify the angioarchitectural feature of all the cases in this group.This section of study was the base of following studies.MethodsWe reviewed and collected the data of 199 AVMs patients with complete past history and cerebral angiograms treated in our hospital from January 1999 to February 2009.As to the clinical presentation, the patients were divided into 3 groups according to their situations on the first admission:intracranial hemorrhage, epilepsy, and other presentations. Demographic We analyzed and recorded the basic clinical elements of each patient such as gender, carefully read each patient's angioarchitectural features, such as location, size, blood supply, anddraining venous etc. and marked each angiroarchitectural feature of all the malformed vessels following a certain standard.The data were synthesized and processed with SPSS 13.0 statistical software package.Results(1)There were four multiple AVM cases, each including 2 lesions. Overall, there were 199 cases ofAVMs. among which,112 happened in male patients, and the rest 87 in female patien(2)Among the 199 cases ofAVMs,94(47.2%)were intracranial hemorrhage,60were epilepsy, and 45 had other clinical presentations.According to statistic examination, the significant differences in clinical presentations were attributed to following factors:AVM location, AVM size, the panern and amount of drainage, the panern and amount of feeding arteries, accompanying intracrani aneurysms and so onSection twoHigh risk angioarehitectural factors of hemorrhage in brain arteriovenous malformationsObjectiveTo study the relationship between the characteristics of DSA and factors of bleeding on cerebral arteriovenous malformation,to judge the risk of bleeding and provide clinical therapeutic program.MethodsWe reviewed and studied the clinical presentations of the 199cases of brain AVMs and concluded the angioarchitectural features between the hemorrhagic group and non—hemorrhagic group by comparison.All possible factors were analyzed by univariate analyses, then the significant factors from univariate analyses were used to construct a multivariate model relating the above features to the occurrence of hemorrhage.The multivariate model was processed by Binary Logistic Regression with SPSSI31.0 statistical software package.For all tests,a P value less than 0.05 was considered to be of statistical significance.ResultsBy univariate analysis,micro-sized and small AVM,deep location,exclusively deep draining veins,fewer draining veins,deep feeding arteries,size,position and number of concurrent aneurysms,following angioma-like predicted hemorrhagic presentation.The presence of feeding arteries position were not correlated with hemorrhagic presentation.when we used stepwise multiple logistic regression analysi micro-sized (0.5～1.0 cm) and small AVM (1.0～2.0 cm), infratentorial AVM, pathway of draining veins,feeding artery aneurysms were independent predictors(P<0.05)of hemorrhagic presentation.Conclusionmicro-sized and small AVM,deep draining veins feeding artery aneursms are most powerful risk predictors for hemorrhagic AVM presentation.