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Angiographic factors leading to hemorrhage in AVMs: A systematic review and meta-analysis

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Abstract

For patients with unruptured intracranial arteriovenous malformations (AVMs), the risk of a hemorrhagic event is approximately 2% to 4% annually. These events have an associated 20—50% morbidity and 10% mortality rate. An understanding of risk factors that predispose these lesions to rupture is important for optimal management. We aimed to pool a large cohort of both ruptured and unruptured AVMs from the literature with the goal of identifying angiographic risk factors that contribute to rupture. A systematic review of the literature was conducted in accordance with the PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science databases. Studies that presented patient-level data from ruptured AVMs from January 1990 to January 2022 were considered for inclusion. The initial screening of 8,304 papers resulted in a quantitative analysis of 25 papers, which identified six angiographic risk factors for AVM rupture. Characteristics that significantly increase the odds of rupture include the presence of aneurysm (OR = 1.45 [1.19, 1.77], p < 0.001, deep location (OR = 3.08 [2.56, 3.70], p < 0.001), infratentorial location (OR = 2.79 [2.08, 3.75], p < 0.001), exclusive deep venous drainage (OR = 2.50 [1.73, 3.61], p < 0.001), single venous drainage (OR = 2.97 [1.93, 4.56], p < 0.001), and nidus size less than 3 cm (OR = 2.54 [1.41, 4.57], p = 0.002). Although previous literature has provided insight into AVM rupture risk factors, obscurity still exists regarding which risk factors pose the greatest risk. We have identified six major angiographic risk factors (presence of an aneurysm, deep location, infratentorial location, exclusive deep venous drainage, single venous drainage, and nidus size less than 3 cm) that, when identified by a clinician, may help to tailor patient-specific approaches and guide clinical decisions.

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Data Availability

The data that support the findings of this study are derived from publically available sources in the literature and all the data supporting the findings of this study are displayed within the article.

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Authors and Affiliations

  1. Department of Neurosurgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA

    Aaron Yengo-Kahn, Steven Roth, Rohan Chitale & Michael Dewan

  2. Hospital Miguel Couto Neurological Surgery, Rio de Janeiro, Brazil

    Savio Batista & Raphael Bertani

  3. Vanderbilt University School of Medicine, Nashville, TN, USA

    Stefan W. Koester

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  1. Stefan W. Koester
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Stefan Koester, Savio Batista, Aaron Yengo-Kahn, Steven Roth, Rohan Chitale, and Michael Dewan. The first draft of the manuscript was written by Stefan Koester, Savio Batista, and Raphael Bertani and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Koester, S.W., Batista, S., Bertani, R. et al. Angiographic factors leading to hemorrhage in AVMs: A systematic review and meta-analysis. Neurosurg Rev 46, 72 (2023). https://doi.org/10.1007/s10143-023-01971-z

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