2025 Proffered Presentations
S130: HEMODYNAMIC CLASSIFICATION OF CEREBRAL ARTERIOVENOUS MALFORMATIONS: A STATISTICAL MODEL TO BETTER PREDICT THE RISK OF HEMORRHAGE
Marta Rico Pereira, M, D; Hospital de la Santa Creu i Sant Pau
Objectives: Treatment of brain arteriovenous malformations (AVMs) remains controversial. A new classification regarding the future risk of rupture is needed in order to estimate the risk of hemorrhage and help in the decision-making. Our aim is to determine if the hemodynamic classification of AVMs is a risk factor for cerebral hemorrhage, correcting for known risk factors.
Methodology: the angiograms of brain AVMs diagnosed in our center between January 2012 and December 2021 are retrospectively reviewed. The proposed hemodynamic classification divided AVMs into low, medium or high risk of bleeding, taking into account the velocity of blood flow and the angioarchitecture of the AVM. The patients were divided into those who presented with cerebral hemorrhage and those who did not, and through a multivariate analysis it was analyzed whether this hemodynamic classification could be related to the risk of bleeding, correcting for other traditionally known risk factors.
Results: 73 patients were analyzed. Twenty patients were excluded from the analysis. 52 patients were included in the analysis (42% women and 58% men) with a mean age of 40 years. 59% belonged to the "bleeding" group and 41% to the "no bleeding" group. The prevalence of bleeding varied according to the group: 33% at low risk, 56% at medium risk, and 85% at high risk. In the multivariate analysis, this classification was a predictor of bleeding risk (p=0.02). The size > 3cm (p=0.09) and the associated aneurysms (p=0.08) showed a tendency towards a higher bleeding risk. The presence of arterial afferents from a single territory of the circle of Willis (p=0.03) was also an independent risk factor for bleeding.
Conclusions: The present hemodynamic classification of AVMs could stratify the bleeding risk of arteriovenous malformations, as an independent factor. The larger size of the malformation and the presence of aneurysms presented a tendency towards a higher bleeding risk. Single-territorial arterial feeders were an independent risk factor for bleeding.