Published online before print August 2, 2007, doi: 10.1161/STROKEAHA.107.488817
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(Stroke. 2007;38:2405.)
© 2007 American Heart Association, Inc.
Editorials |
When Race/Ethnicity Matters More Than Size
From the Doris & Stanley Tananbaum Stroke Center, Neurological Institute, Columbia University, New York, NY, and Neurovascular Research, Department of Neurology, Ernst-Moritz-Arndt University, Greifswald, FR Germany.
Correspondence to Alexander V. Khaw, Neurovascular Research, Department of Neurology, Ernst-Moritz-Arndt University, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, FR Germany. E-mail akhaw@neuro.columbia.edu; khaw@uni-greifswald.de
Key Words: arteriovenous malformations • epidemiology • intracerebral hemorrhage • intracranial hemorrhage • prognosis • risk factors
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
See related article, pages 2430–2437.
Although cerebral arteriovenous malformations (cAVMs) constitute a rather rare disorder with consistently reported detection rates around 1.2 per 100 000 person-years,1–3 they have gained increasing attention in clinical research for several challenging reasons: despite the still widely accepted notion that the majority of cAVMs are at least preformed as angioarchitectural dysplasias early in life, hypothetically during fetal development,4 no environmental, lifestyle or other risk factors have been reliably identified to estimate when, if at all, the disorder will convert to being symptomatic by its most feared and clinically relevant manifestation, intracranial hemorrhage. Few histopathological and molecular studies suggest alterations in angiogenesis-related homeostasis of growth factors and matrix components,5,6 yet the dynamics of these mechanisms leading to the broad spectrum ranging from hemorrhagic mass-lesions in infancy to small malformations detected incidentally with modern high-resolution imaging in elderly remain obscure. However, the instance a cAVM is discovered, the clinician is challenged with treatment recommendations that will influence the frequently young patients’ lives for decades: how to treat the disorder leading to the diagnosis, how and when to treat the underlying abnormality, and, if the aim is lesion eradication, which therapy modality or which combination among the options of embolization, surgical resection and radiation, to chose? Aside from medical emergencies, the patient expects optimal and evidence-based counseling for risks from each of the treatment options targeting the vascular lesion itself, and no less from pure symptomatic treatment addressing the presenting symptoms, but leaving the AVM untouched. Therefore,
Related Article:
Stroke 2007 38: 2430-2437.