Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients

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FIG 1.
Age distribution at rupture in the study sample.
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FIG 2.
Rupture-free survival according to brain AVM characteristics, Kaplan-Meier survival curves, delay until rupture (age in years), and brain AVM location (A and B), aneurysm presence (C), and venous drainage pattern (D).

Table 1:

Baseline clinical and imaging characteristics^a

Variable	Pediatric (n = 122)	Adult (n = 198)	All (n = 320)	P Value
Clinical presentation
Age (yr)	9.8 ± 3.8	43.3 ± 15.7	30.8 ± 20.6	<.001
Female sex	56 (45.9%)	85 (42.9%)	141 (44.1%)	.62
GCS at baseline	11.6 ± 3.9	12.4 ± 3.7	12.1 ± 3.8	.09
GCS score <9	33 (28%)	38 (21.2%)	71 (23.9%)	.09
Imaging presentation
Hemorrhage location				.45
Supratentorial	92 (76.7%)	128 (72.7%)	220 (74.3%)
Infratentorial	16 (13.3%)	33 (18.8%)	49 (16.6%)
Other (SAH/IVH)	12 (10%)	15 (8.5%)	27 (9.1%)
Hemorrhage volume (mL)^{^b}	19.8 ± 16.7	38.6 ± 35.5	30.6 ± 30.4	<.001
AVM characteristics
Deep location	67 (56.3%)	42 (21.2%)	109 (34.4%)	<.001
Supratentorial location	103 (86.6%)	153 (77.3%)	256 (80.8%)	.052
Nidus max. diameter	24.2 ± 14.3	18.9 ± 14.3	20.9 ± 14.5	.002
Spetzler-Martin grade				.7
I	24 (20.9%)	49 (26.6%)	73 (24.4%)
II	50 (43.5%)	75 (40.8%)	125 (41.8%)
III	27 (23.5%)	44 (23.9%)	71 (23.7%)
IV	10 (8.7%)	11 (6%)	21 (7%)
V	4 (3.5%)	5 (2.7%)	9 (3%)
AVM-related aneurysms
Nidal aneurysm	18 (15.9%)	42 (23.5%)	60 (20.5%)	.03
Prenidal arterial aneurysm	3 (2.7%)	32 (17.9%)	35 (12%)	<.001
AVM venous drainage
Exclusively deep	35 (29.7%)	46 (25.8%)	81 (27.4%)	.87
Any deep drainage	58 (49.2%)	86 (48%)	144 (48.5%)	.85

Note:—IVH indicates intraventricular hemorrhage; GCS, Glasgow Coma Scale; max., maximum.
a Data are presented as absolute count (percentage) and mean ± SD as appropriate.
↵b For 114 and 155 patients with intraparenchymal hemorrhages.

Table 2:

Uni- and multivariable proportional hazards for time to rupture

Variable	Univariable^{^a}			Multivariable^b
Variable	RR	95% CI	P Value	aRR	95% CI	P Value
Brain AVM supratentorial location	1.46	1.21–1.76	<.001	1.19	1.01–1.41	.03
Brain AVM deep location	1.46	1.29–1.65	<.001	1.43	1.22–1.67	<.001
Nidus size	1	1–1.01	.36
Prenidal arterial aneurysm	0.5	0.37–0.65	<.001	0.62	0.46–0.83	<.001
Intranidal aneurysm	1.25	1–1.55	.27
Any deep venous drainage	1.03	0.92–1.16	.61
Exclusively deep venous drainage	1.39	1.16–1.67	.002	1.12	0.9–1.4	.43