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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations
Felipe Padilla-Vazquez1, Marco A Zenteno1, Jorge Balderrama1
1Department of Neuroendovascular Therapy, Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico city, Mexico.
Insights
A new classification for cerebral arteriovenous malformations (AVMs) uses feeding artery velocity, nidus size, and venous drainage to predict rupture risk. This tool helps assess individual AVMs for hemorrhage potential.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Cerebral arteriovenous malformations (AVMs) present a treatment dilemma due to uncertain rupture risk.
- Predictive factors are needed to stratify AVMs into low or high rupture risk categories.
- Current assessment methods require enhancement with hemodynamic and anatomic data.
Purpose of the Study:
- To develop a novel classification system for assessing the rupture risk of cerebral AVMs.
- To integrate hemodynamic and anatomic factors into a rapid risk assessment tool.
- To aid in the individualization of treatment decisions for AVM patients.
Main Methods:
- Retrospective analysis of 639 patients with cerebral AVMs (ruptured and unruptured).
- Development of a 1-4 point classification score based on feeding artery mean velocity (Vm), nidus size, and venous drainage type.
- Statistical analysis using descriptive statistics and logistic regression.
Main Results:
- Logistic regression confirmed Vm, nidus size, and venous drainage type significantly predict AVM rupture odds (P = 0.0001, R² = 0.437).
- Grades 1 and 2 of the new classification indicated low hemorrhage risk.
- Grades 3 and 4 indicated significantly increased hemorrhage risk, with odds ratios ranging from 3.292 to 23.304.
Conclusions:
- The proposed classification system is effective and user-friendly for assessing cerebral AVM rupture risk.
- It facilitates personalized risk assessment for individual AVMs.
- This classification can support clinical decision-making regarding AVM management.
Background:
Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.
Methods:
This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1-4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.
Results:
A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061-0.188), 2 point OR = (0.227 95% CI; 0.153-0.338), 3 point OR = (3.292 95% CI; 2.325-4.661), and 4 point OR = (23.304 95% CI; 11.077-49.027).
Conclusion:
This classification is useful and easy to use, and it may allow for the individualisation of each cerebral AVM and the assessment of rupture risk based on a model of categorisation.
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