Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Clin Neurosci. 2012 Aug;19(8):1087-8. doi: 10.1016/j.jocn.2011.12.005. Epub 2012 Jun 15.
Prior rupture is an established risk factor for subsequent hemorrhage from arteriovenous malformations (AVM). Recent natural history studies have reinvigorated the important concept that the re-bleed rate is not constant; rather, it is particularly greater in the first year after hemorrhage. In this study, we reviewed our own cohort of 129 patients with AVMs. Eighty-one presented with hemorrhage (63%), and of these patients, 38 had at least one month of subsequent clinical follow-up and were included in our analysis. Over a total of 140 patient-years, the annual re-hemorrhage rate was 7.9%, though it was 15.8% in the first year. Two-thirds of those AVM that hemorrhaged in the first year were associated with aneurysms. The overall permanent morbidity of re-hemorrhage was 45%; the mortality rate was 9%. Although the re-hemorrhage rate in the first year varied from 6% to 15.8% across series in the literature, it was generally double the overall re-hemorrhage rate provided in each study. These results have significant therapeutic implications, favoring surgical treatment of ruptured AVM and/or their associated aneurysm when feasible to avoid the incumbent greater risk of early rehemorrhage.
先前的破裂是动静脉畸形（AVM）随后出血的既定危险因素。最近的自然史研究重新激发了一个重要概念，即再出血率不是恒定的；相反，它在出血后第一年特别更高。在这项研究中，我们回顾了我们自己的 129 例 AVM 患者队列。81 例出现出血（63%），其中 38 例至少有一个月的后续临床随访并纳入我们的分析。在总共 140 个患者年中，年再出血率为 7.9%，尽管在第一年为 15.8%。在出血的第一年中，三分之二的 AVM 与动脉瘤有关。再出血的总永久性发病率为 45%；死亡率为 9%。尽管文献中各系列的第一年再出血率在 6%至 15.8%之间变化，但总体再出血率通常是每个研究报告的再出血率的两倍。这些结果具有重要的治疗意义，有利于在可行的情况下对破裂的 AVM 及其相关的动脉瘤进行手术治疗，以避免早期再出血的风险增加。
