Khaw A V, Mohr J P, Sciacca R R, Schumacher H C, Hartmann A, Pile-Spellman J, Mast H, Stapf C
Stroke Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Stroke. 2004 Mar;35(3):660-3. doi: 10.1161/01.STR.0000117093.59726.F9. Epub 2004 Jan 29.
The goal of this study was to analyze the association of hemorrhagic presentation with infratentorial brain arteriovenous malformations (AVMs).
The 623 consecutive, prospectively enrolled patients from the Columbia AVM Databank were analyzed in a cross-sectional study. Clinical presentation (diagnostic event) was categorized as intracranial hemorrhage or nonhemorrhagic presentation. From brain imaging and cerebral angiography, AVM location was classified as either infratentorial or supratentorial. Univariate and multivariate statistical models were applied to test the effect of age, sex, AVM size and location, venous drainage pattern, and associated (ie, feeding artery or intranidal) arterial aneurysms on the likelihood of hemorrhage at initial AVM presentation.
Of the 623 patients, 72 (12%) had an infratentorial and 551 (88%) had a supratentorial AVM. Intracranial hemorrhage was the presenting symptom in 283 patients (45%), and infratentorial AVM location was significantly more frequent (18%) among patients who bled initially (6%; odds ratio [OR], 3.60; 95% confidence interval [CI], 2.09 to 6.20). This difference remained significant (OR, 1.99; 95% CI, 1.07 to 3.69) in the multivariate logistic regression model controlling for age, sex, AVM size, deep venous drainage, and associated arterial aneurysms. In the same model, the effect of other established determinants for AVM hemorrhage--ie, AVM size (in 1-mm increments; OR, 0.95; 95% CI, 0.94 to 0.96), deep venous drainage (OR, 3.09; 95% CI, 1.87 to 5.12), and associated aneurysms (OR, 2.78; 95% CI, 1.76 to 4.40)--remained significant.
Our findings suggest that infratentorial AVM location is independently associated with hemorrhagic AVM presentation.
本研究旨在分析幕下脑动静脉畸形（AVM）与出血性表现之间的关联。
在一项横断面研究中，对来自哥伦比亚AVM数据库的623例连续前瞻性入组患者进行了分析。临床表现（诊断事件）分为颅内出血或非出血性表现。根据脑部影像学和脑血管造影，AVM位置分为幕下或幕上。应用单变量和多变量统计模型，以检验年龄、性别、AVM大小和位置、静脉引流模式以及相关（即供血动脉或瘤巢内）动脉瘤对初次AVM表现时出血可能性的影响。
在623例患者中，72例（12%）有幕下AVM，551例（88%）有幕上AVM。283例患者（45%）以颅内出血为首发症状，幕下AVM位置在最初出血的患者中显著更常见（18%），而非出血患者中为6%；优势比（OR）为3.60；95%置信区间（CI）为2.09至6.20。在控制年龄、性别、AVM大小、深部静脉引流和相关动脉瘤的多变量逻辑回归模型中，这种差异仍然显著（OR为1.99；95%CI为1.07至3.69）。在同一模型中，其他已确定的AVM出血决定因素的影响——即AVM大小（以1毫米增量；OR为0.95；95%CI为0.94至0.96）、深部静脉引流（OR为3.09；95%CI为1.87至5.12）和相关动脉瘤（OR为2.78；95%CI为1.76至4.40）——仍然显著。
我们的研究结果表明，幕下AVM位置与出血性AVM表现独立相关。
