title: Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations.
abstract: OBJECTIVE
  The purpose of this study was to define the influence of feeding mean arterial pressure (FMAP) in conjunction with other morphological or clinical risk factors in determining the probability of hemorrhagic presentation in patients with cerebral arteriovenous malformations (AVMs).
  
  
  METHODS
  Clinical and angiographic data from 340 patients with cerebral AVMs from a prospective database were reviewed. Patients were identified in whom FMAP was measured during superselective angiography. Additional variables analyzed included AVM size, location, nidus border, presence of aneurysms, and arterial supply and venous drainage patterns. The presence of arterial aneurysms was also correlated with site of bleeding on imaging studies.
  
  
  RESULTS
  By univariate analysis, exclusively deep venous drainage, periventricular venous drainage, posterior fossa location, and FMAP predicted hemorrhagic presentation. When we used stepwise multiple logistic regression analysis in the cohort that had FMAP measurements (n = 129), only exclusively deep venous drainage (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.4 to 9.8) and FMAP (OR, 1.4 per 10 mm Hg increase; 95% CI, 1.1 to 1.8) were independent predictors (P < 0.01) of hemorrhagic presentation; size, location, and the presence of aneurysms were not independent predictors. There was also no association (P = 0.23) between the presence of arterial aneurysms and subarachnoid hemorrhage.
  
  
  CONCLUSIONS
  High arterial input pressure (FMAP) and venous outflow restriction (exclusively deep venous drainage) were the most powerful risk predictors for hemorrhagic AVM presentation. Our findings suggest that high intranidal pressure is more important than factors such as size, location, and the presence of arterial aneurysms in the pathophysiology of AVM hemorrhage.
authors.affiliation: Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Duong
authors.forename: W L
authors.initials: WL
authors.lastname: Young
authors.forename: M C
authors.initials: MC
authors.lastname: Vang
authors.forename: R R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: H
authors.initials: H
authors.lastname: Mast
authors.forename: H C
authors.initials: HC
authors.lastname: Koennecke
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: S
authors.initials: S
authors.lastname: Joshi
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: J
authors.initials: J
authors.lastname: Pile-Spellman
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005911:Gliosis / Q000000981:diagnostic imaging; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D002538:Intracranial Arteriovenous Malformations / Q000453:epidemiology / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014690:Venous Pressure / Q000502:physiology