title: Features predictive of brain arteriovenous malformation hemorrhage: extrapolation to a physiologic model.
abstract: OBJECTIVE
  Although there is generally thought to be a 2% to 4% per annum rupture risk for brain arteriovenous malformations (bAVMs), there is no way to estimate risk for an individual patient.
  
  
  METHODS
  In this retrospective study, patients were eligible who had nidiform bAVMs and underwent detailed pretreatment diagnostic cerebral angiography at our medical center from 1996 to 2006. All patients had superselective microcatheter angiography, and films were reviewed for the purpose of this project. Patient demographics, clinical presentation, and angioarchitectural characteristics were analyzed. A univariate analysis was performed, and angioarchitectural features with potential physiological significance that showed at least a trend toward significance were added to a multivariate logistic regression model.
  
  
  RESULTS
  One hundred twenty-two bAVMs met criteria for study entry. bAVMs with single venous drainage anatomy were more likely to present with hemorrhage. In addition, patients with multiple draining veins and a venous stenosis reverted to a risk similar to those with 1 draining vein, whereas those with multiple draining veins and without stenosis had diminished association with hemorrhage presentation. Those bAVMs with associated aneurysms were more likely to present with hemorrhage. These findings were robust in both univariate and multivariate models.
  
  
  CONCLUSIONS
  The results of this article lead to the first physiological, internally consistent model of individual bAVM hemorrhage risk, where 1 draining vein, venous stenosis, and associated aneurysms increase risk.
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Sahlein
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: Paloma
authors.initials: P
authors.lastname: Mora
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: Tibor
authors.initials: T
authors.lastname: Becske
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: Paul
authors.initials: P
authors.lastname: Huang
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: Jafar J
authors.initials: JJ
authors.lastname: Jafar
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.).
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: From the Departments of Neurology (D.H.S., T.B.), Radiology (D.H.S., P.M., T.B., P.K.N.), and Neurosurgery (P.H., J.J.J., P.K.N.), NYU Langone Medical Center; Department of Radiology, Hospital Bellvitge, Barcelona, Spain (P.M.); and Department of Neurosurgery, Columbia University Medical Center, New York, NY (E.S.C.). nelsop01@med.nyu.edu.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000367:Age Factors; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology*; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D014680:Veins / Q000473:pathology
keywords: arteriovenous malformations; cerebral hemorrhage; hemorrhage; stroke