Abstract W P414: Midterm Clinical Outcomes After Intervention versus Conservative Management for Brain Arteriovenous Malformation
Purpose: Brain arteriovenous malformation (AVM) patients presented in our institution were divided into two groups based on the initial treatment strategy, “intervention” vs. “conservative management”, and the mid-term clinical outcomes of the two groups were compared.
Methods: A total of 149 AVM patients were enrolled in this study. After thorough discussions with each patient on the risk and benefit of the treatment, 83 patients underwent either endovascular, surgical intervention, radiosurgery or combination of these different modalities (Group A). 66 patients chose conservative management until hemorrhage or clinical worsening from the AVM occurred (Group B). In each group, 1) the type of the initial presentation, 2) Spetzler-Martin (S-M) Grade, 3) modified Rankin Scale (mRS) and 4) symptomatic bleeding or neurological deterioration during the follow-ups were recorded. The clinical outcomes of each group was compared.
Results: Group A; The type of initial presentation was, bleeding 45%, epilepsy 21%, incidental 18%, headache 8%, focal neurological deficit 5% and others 2%. During the average observation period of 1569 days, 42 patients (51%) showed angiographical obliteration. Overall complications were seen in 15 patients (18%). Complications with neurological deterioration (mRS≧3) was seen in 2 patients (2.4%).
Group B; The type of initial presentation was, incidental 33%, epilepsy 23%, bleeding 18%, headache 17%, focal neurological symptoms 3% and others 6%. During the follow-ups (778 days), 7 patients (10%) had hemorrhage or neurological deterioration, and all of them underwent treatment. One patient died immediately before the surgery due to substantial re-bleeding. Rupture rate was 4.5% / year, and neurological sequela (mRS≧3) was seen in 2.7% in this group.
Conclusion: The risk of neurological deterioration during the observation period was similar in both groups. Considering the “treatment group” has higher risk of bleeding, the intervention (s) might have contributed to the prevention of the neurological deterioration. However, given the limited magnitude of neurological sequela induced by the bleeding, caution should be exercised in determining the treatment indications especially for the asymptomatic patients.
Author Disclosures: I. Yuki: None. T. Suzuki: None. H. Arakawa: None. T. Ishibashi: None. S. Kaku: None. I. Kan: None. K. Nishimura: None. A. Ikemura: None. Y. Kambayashi: None.
- © 2015 by American Heart Association, Inc.