Predicting Hemorrhage Risk in Patients With Vascular Malformations

arteriovenous malformation brain
arteriovenous malformation brain
The investigators of this study did not compare pre- or post-hemorrhage data, precluding their ability to determine the applicability of the findings for improving clinical practice.

In persons younger than 45, the presence of a cavernous malformation (CM) in the infratentorial region and the existence of a developmental venous anomaly (DVA) are reliable predictors for the risk of hemorrhage, according to retrospective findings published in Neurology.

In this retrospective analysis, investigators obtained medical records of 154 patients with a CM who were admitted to a single center between 1999 and 2016. Investigators evaluated patients’ baseline characteristics (eg, age, antithrombotic therapy, hypertension, and sex), lesion locations, presence of DVA, and cavernoma volume. For the primary outcome, investigators sought to identify the presence of ≥1 ruptured CM to identify risk factors for hemorrhage.

In the cohort, a total of 89 patients (58%) had ≥1 CM rupture upon hospital admission. Participants with ruptures were significantly more likely to have a DVA compared with patients with ruptures (odds ratio [OR] 4.6, P <.001) in the univariable analysis. In the multivariable analysis, young age (<45) (OR 2.2, P <.05), a rupture in the infratentorial region (OR 2.9, P <.01), and the presence of a DVA (OR 4.7, P <.0001) emerged as significant risk factors for hemorrhage.

In addition, CM volume ≥1 cm3 in the ruptured infratentorial region (OR 3.5; P <.0001) and the presence of a DVA in the ruptured supratentorial location (OR 4.16; P <.01) represented additional predictors of hemorrhage risk in these patients.

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The study investigators did not compare pre- or post-hemorrhage data, precluding their ability to determine the applicability of the findings to improving clinical practice. In addition, the study’s findings may not generalize to patients with CMs in other locations such as the spine, due to the limited patient sample.

Findings from the study suggest that the presence of DVA and ruptures located in the infratentorial region in patients younger than 45 are key independent hemorrhage risk predictors that may “have a key role in deciding patients’ surgical or radiosurgical treatment as well as keeping them under clinical and radiologic observation.”


Kashefiolasl S, Bruder M, Brawanski N, et al. A benchmark approach to hemorrhage risk management of cavernous malformations. Neurology. 2018;90(10):e856-e863.