PT  - JOURNAL ARTICLE
AU  - Garzelli, L.
AU  - Shotar, E.
AU  - Blauwblomme, T.
AU  - Sourour, N.
AU  - Alias, Q.
AU  - Stricker, S.
AU  - Mathon, B.
AU  - Kossorotoff, M.
AU  - Gariel, F.
AU  - Boddaert, N.
AU  - Brunelle, F.
AU  - Meyer, P.
AU  - Naggara, O.
AU  - Clarençon, F.
AU  - Boulouis, G.
TI  - Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients
AID  - 10.3174/ajnr.A6824
DP  - 2020 Dec 01
TA  - American Journal of Neuroradiology
PG  - 2358--2363
VI  - 41
IP  - 12
4099  - http://www.ajnr.org/content/41/12/2358.short
4100  - http://www.ajnr.org/content/41/12/2358.full
SO  - Am. J. Neuroradiol.2020 Dec 01; 41
AB  - BACKGROUND AND PURPOSE: 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.MATERIALS AND METHODS: 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.RESULTS: 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%, P < .001), with a larger nidus (24.2  versus 18.9 mm, P = .002), were less frequently nidal (15.9% versus 23.5%, P = .03) and arterial aneurysms (2.7% versus 17.9%, P < .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; P = .03 and adjusted relative risk, 1.43; 95% CI, 1.22–1.67; P < .001, respectively) and exclusively deep venous drainage (adjusted relative risk, 1.46, 95% CI, 1.21–1.76; P < .001) were associated with earlier rupture, whereas arterial or nidal aneurysms were associated with rupture later in life.CONCLUSIONS: 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.HRhazard ratio