Relationship of nidal vessel radius and wall thickness to brain arteriovenous malformation hemorrhage.
Cerebral (brain) arteriovenous malformations (BAVMs) are a tangle of disorganized vessels that are a rare cause of hemorrhagic stroke in the general population. Although clinical presentation of hemorrhage may be related to the structure of BAVM vessels, there has been no systematic quantitative analysis of BAVM vessel morphology. Histological sections of excised BAVM lesions were prepared from patients who presented with hemorrhage (n = 14) and from patients with no history of hemorrhage (n = 22). Mean values of radius and wall thickness in each section were determined. BAVM radii were 422+/-136 microm (mean +/- SD), minimum wall thickness (thinnest portion of the wall) was 54+/-14 microm; and the minimum thickness/radius ratio was 0.23+/-0.07. Greater vessel wall thickness was associated with hemorrhagic presentation (OR= 1.1; p = 0.046) after adjusting for feeding artery pressure. Because BAVM vessels from patients presenting with hemorrhage had thicker vessel walls, the search for structural properties predisposing BAVM rupture should be expanded beyond the morphological properties analyzed here.
Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco 94110, USA. quickc@anesthesia.ucsf.edu
Christopher M
CM
Quick
David J
DJ
James
Kelvin
K
Ning
Shailandra
S
Joshi
Alexander X
AX
Halim
Tomoki
T
Hashimoto
William L
WL
Young
D000328:Adult; D000886:Anthropometry; D001808:Blood Vessels / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged