Cerebral vasospasm following arteriovenous malformation rupture: a population-based longitudinal study

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Vasospasm is a serious complication following ruptured arteriovenous malformations (AVMs).
• Previous studies on risk factors were limited to cross-sectional designs.
• This study aimed to identify predictors of vasospasm and mortality in ruptured AVM patients.

Purpose of the Study:

• To characterize risk factors for vasospasm and mortality in adult patients with ruptured AVMs.
• To analyze the association between vasospasm and long-term mortality.
• To identify key clinical indicators present on admission that predict adverse outcomes.

Main Methods:

• Retrospective cohort study utilizing the TriNetX Research Network over 20 years.
• Included adult patients diagnosed with ruptured AVMs using ICD-10 codes.
• Cox proportional hazard models assessed vasospasm and mortality, adjusting for numerous covariates.

Main Results:

• Vasospasm occurred in 3.0% of 10,375 ruptured AVM patients within 30 days.
• Vasospasm was linked to significantly increased mortality at 3 months, 6 months, and 1 year.
• Key vasospasm risk factors included subarachnoid hemorrhage, hydrocephalus, and leukocytosis; male sex was a risk factor, while female sex was protective.
• Major mortality risk factors were coma, hydrocephalus, and chronic kidney disease.

Conclusions:

• Vasospasm is a significant predictor of increased mortality in ruptured AVM patients.
• Subarachnoid hemorrhage, hydrocephalus, and leukocytosis are critical risk factors for vasospasm.
• Identifying these risk factors can guide preventative strategies and improve patient outcomes in ruptured AVM cases.