Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil.
Division of Interventional Neuroradiology, Hospital das Clínicas de Passo Fundo, Passo Fundo, RS, Brazil.
Neuroradiology. 2020 Nov;62(11):1497-1505. doi: 10.1007/s00234-020-02484-y. Epub 2020 Jun 30.
Intracranial arteriovenous malformations (AVMs) cause hemorrhage, and the role of draining vein diameters in rupture risk is controversial. The aims of the present study were to investigate the variables related with intracranial AVM rupture and to examine the association of draining vein diameters and AVM hemorrhage.
Two hundred three patients were included in this study, of which 117 (57%) had unruptured AVMs, and 86 (43%) had ruptured AVMs.
In an adjusted (multivariate) analysis, the variables significantly associated with AVM hemorrhagic presentation were age (OR per year increase 0.97, 95%CI 0.95-0.99, p = 0.007), a deep nidus compared with superficial nidus (OR 3.21, 95%CI 1.13-9.06, p = 0.028), the nidus diameter (OR per each mm increase 0.95, 95%CI 0.92-0.97, p < 0.001), a single draining vein compared with multiple draining veins (OR 2.14, 95%CI 1.02-4.50, p = 0.044), the draining vein diameter (OR per mm increase 1.52, 95%CI 1.26-1.83, p < 0.001), and a draining vein diameter ≥ 5 mm compared with < 5 mm (OR 5.80, 95%CI 2.70-12.47, p < 0.001).
In this study, after adjusted analysis, the variables associated with intracranial AVM hemorrhagic presentation were a young age, a small nidus diameter, a deeply located nidus, a single draining vein, and large draining vein diameters. A draining vein diameter cutoff ≥ 5 mm was positively associated with the risk of AVM rupture. A large and prospective study is now necessary to confirm if draining vein diameter is a risk factor for AVM hemorrhage.
颅内动静脉畸形（AVM）可导致出血，引流静脉直径与破裂风险的关系存在争议。本研究旨在探讨与颅内 AVM 破裂相关的变量，并研究引流静脉直径与 AVM 出血的关系。
本研究纳入 203 例患者，其中 117 例（57%）为未破裂 AVM，86 例（43%）为破裂 AVM。
在调整（多变量）分析中，与 AVM 出血表现显著相关的变量为年龄（每年增加 0.97，95%CI 0.95-0.99，p=0.007）、深部病灶与表浅病灶（OR 3.21，95%CI 1.13-9.06，p=0.028）、病灶直径（每增加 1 毫米，OR 0.95，95%CI 0.92-0.97，p<0.001）、单根引流静脉与多根引流静脉（OR 2.14，95%CI 1.02-4.50，p=0.044）、引流静脉直径（每增加 1 毫米，OR 1.52，95%CI 1.26-1.83，p<0.001）、以及引流静脉直径≥5mm 与<5mm（OR 5.80，95%CI 2.70-12.47，p<0.001）。
在本研究中，经调整分析后，与颅内 AVM 出血表现相关的变量为年龄较小、病灶直径较小、病灶位置较深、单根引流静脉和较大的引流静脉直径。引流静脉直径≥5mm 与 AVM 破裂风险呈正相关。目前需要进行一项大型前瞻性研究，以确定引流静脉直径是否为 AVM 出血的危险因素。
