Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients
Lorenzo Garzelli, Eimad Shotar, Thomas Blauwblomme, Nader Sourour, Quentin Alias, Sarah Stricker, Bertrand Mathon, Manoëlle Kossorotoff, Florent Gariel, Nathalie Boddaert, Françis Brunelle, P Meyer, Olivier Naggara, Frédéric Clarençon, Grégoire Boulouis
Abstract
<h3>BACKGROUND AND PURPOSE:</h3> Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. <h3>MATERIALS AND METHODS:</h3> Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. <h3>RESULTS:</h3> Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, <i>P </i>< .001), with a larger nidus (24.2 versus 18.9 mm, <i>P</i> = .002), were less frequently nidal (15.9% versus 23.5%, <i>P </i>= .03) and arterial aneurysms (2.7% versus 17.9%, <i>P </i>< .001), and had similar drainage patterns or Spetzler-Martin grades. In the fully adjusted Cox model, supratentorial, deep brain AVM locations (adjusted relative risk, 1.19; 95% CI, 1.01–1.41; <i>P</i> = .03 and adjusted relative risk, 1.43; 95% CI, 1.22–1.67; <i>P</i> < .001, respectively) and exclusively deep venous drainage (adjusted relative risk, 1.46, 95% CI, 1.21–1.76; <i>P</i> < .001) were associated with earlier rupture, whereas arterial or nidal aneurysms were associated with rupture later in life. <h3>CONCLUSIONS:</h3> The angioarchitecture of ruptured brain AVMs significantly varies across the life span. These distinct features may help to guide treatment decisions for patients with unruptured AVMs.