Abstract 195: The Natural History and Predictive Factors of Hemorrhage from Choroidal (Intraventricular) Brain Arteriovenous Malformations
Background: The natural history and risk of hemorrhage for patients harbouring choroidal/ intraventricular AVMs is poorly understood. We examined the impact of demographic and angiographic features on the likelihood of future hemorrhage.
Methods: A prospectively maintained database from the Toronto Western Hospital was analyzed. Inclusion criteria were AVMS that were entirely intraventricular and supplied predominantly from choroidal arteries (anterior/ posterior). The rate of hemorrhage over long term follow up was calculated. The impact of baseline clinical and angio-architectural on time to hemorrhage were analyzed using survival analysis and compared with the total AVM population (n = 1018).
Results: 44 patients (median age 27, range 2 - 72 years) identified with choroidal AVMs (4.4% of all AVMs) were followed for 151 patient years. 36 patients (82%) presented with hemorrhage (vs 39% for all AVMs), 28 (77%) of which were predominantly intraventricular. Hemorrhage rates were 7.3%/ year (vs 1.7%/year for all AVMs, HR 2.3, p<0.001). The presence of venous reflux into thalamostriate or cortical veins was a significant independent risk factor for future hemorrhage (HR 1.80, p =0.047) with intranidal aneurysms not significantly associated with future hemorrhage risk (HR = 1.3, p =0.18).
Conclusion: Choroidal AVMs are more likely to present with hemorrhage, particularly of the intraventricular type and are associated with approximately 2-fold greater likelihood of future hemorrhage, especially in the presence of venous reflux.
Author Disclosures: R.H. Sacho: None. G. Saliou: None. M. Tymianski: None. T. Krings: None. K. Terbrugge: None.
- © 2015 by American Heart Association, Inc.