Outcome after interventional or conservative management of unruptured brain arteriovenous malformations

a prospective, population-based cohort study

Catherine J Wedderburn, Janneke van Beijnum, Jo J Bhattacharya, Carl E Counsell, Vakis Papanastassiou, Vaughn Ritchie, Richard C Roberts, Robin J Sellar, Charles P Warlow, Rustam Al-Shahi Salman, SIVMS Collaborators

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background
The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not.

Methods
All adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51).

Findings
At presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up.

Interpretation
Greater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.
Original languageEnglish
Pages (from-to)223-230
Number of pages8
JournalThe Lancet neurology
Volume7
Issue number3
Early online date1 Feb 2008
DOIs
Publication statusPublished - Mar 2008

Fingerprint

Arteriovenous Malformations
Cohort Studies
Brain
Population
Therapeutics
Intracranial Hemorrhages
Scotland
Survival Analysis
Conservative Treatment
Comorbidity
Seizures
Odds Ratio

Keywords

  • adolescent
  • adult
  • aged
  • aged, 80 and over
  • cohort studies
  • community health planning
  • female
  • humans
  • intracranial arteriovenous malformations
  • male
  • middle aged
  • proportional hazards models
  • retrospective studies
  • risk factors
  • Scotland
  • severity of illness index
  • survival analysis
  • time factors

Cite this

Outcome after interventional or conservative management of unruptured brain arteriovenous malformations : a prospective, population-based cohort study. / Wedderburn, Catherine J; van Beijnum, Janneke; Bhattacharya, Jo J; Counsell, Carl E; Papanastassiou, Vakis; Ritchie, Vaughn; Roberts, Richard C; Sellar, Robin J; Warlow, Charles P; Al-Shahi Salman, Rustam; SIVMS Collaborators.

In: The Lancet neurology, Vol. 7, No. 3, 03.2008, p. 223-230.

Research output: Contribution to journalArticle

Wedderburn, CJ, van Beijnum, J, Bhattacharya, JJ, Counsell, CE, Papanastassiou, V, Ritchie, V, Roberts, RC, Sellar, RJ, Warlow, CP, Al-Shahi Salman, R & SIVMS Collaborators 2008, 'Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study', The Lancet neurology, vol. 7, no. 3, pp. 223-230. https://doi.org/10.1016/S1474-4422(08)70026-7
Wedderburn, Catherine J ; van Beijnum, Janneke ; Bhattacharya, Jo J ; Counsell, Carl E ; Papanastassiou, Vakis ; Ritchie, Vaughn ; Roberts, Richard C ; Sellar, Robin J ; Warlow, Charles P ; Al-Shahi Salman, Rustam ; SIVMS Collaborators. / Outcome after interventional or conservative management of unruptured brain arteriovenous malformations : a prospective, population-based cohort study. In: The Lancet neurology. 2008 ; Vol. 7, No. 3. pp. 223-230.
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AU - Wedderburn, Catherine J

AU - van Beijnum, Janneke

AU - Bhattacharya, Jo J

AU - Counsell, Carl E

AU - Papanastassiou, Vakis

AU - Ritchie, Vaughn

AU - Roberts, Richard C

AU - Sellar, Robin J

AU - Warlow, Charles P

AU - Al-Shahi Salman, Rustam

AU - SIVMS Collaborators

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N2 - BackgroundThe decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not.MethodsAll adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51).FindingsAt presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up.InterpretationGreater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.

AB - BackgroundThe decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not.MethodsAll adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51).FindingsAt presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up.InterpretationGreater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.

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KW - adult

KW - aged

KW - aged, 80 and over

KW - cohort studies

KW - community health planning

KW - female

KW - humans

KW - intracranial arteriovenous malformations

KW - male

KW - middle aged

KW - proportional hazards models

KW - retrospective studies

KW - risk factors

KW - Scotland

KW - severity of illness index

KW - survival analysis

KW - time factors

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