title: Subsequent haemorrhage in children with untreated brain arteriovenous malformation: Higher risk with unbalanced inflow and outflow angioarchitecture.
abstract: OBJECTIVE
  Children with brain arteriovenous malformations (bAVMs) are at risk of life-threatening haemorrhage in their early lives. Our aim was to analyse various angioarchitectural features of bAVM to predict the risk of subsequent haemorrhage during follow-up in children.
  
  
  METHODS
  We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. Annual rates of AVM rupture as well as several potential risk factors for subsequent haemorrhage were analysed using Kaplan-Meier analyses and Cox proportional hazards regression models.
  
  
  RESULTS
  We identified 110 paediatric patients with a mean follow-up period of 2.1 years (range, 1 month-15.4 years). The average annual risk of haemorrhage from untreated AVMs was 4.3 % in children. No generalised venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent haemorrhage (RR, 7.55; 95 % CI 1.96-29.06). The annual rupture risk was 11.1 % in bAVMs without generalised venous ectasia but with fast arteriovenous shunt.
  
  
  CONCLUSIONS
  bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for future haemorrhage.
  
  
  CONCLUSIONS
  • Haemorrhage risk stratification is important for children with untreated brain AVM. • Angiographic features suggesting unbalanced inflow and outflow predict paediatric brain AVM haemorrhage. • Identifying AVMs with high rupture risk help patient selection and tailoring treatment.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.|Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.|Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050.
authors.forename: Chun-Xue
authors.initials: CX
authors.lastname: Wu
authors.affiliation: Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050. dr_ma@sina.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, People's Republic of China, 100050. zhaoyuanli@126.com.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. zhaoyuanli@126.com.|Stroke Center, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. zhaoyuanli@126.com.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China. zhaoyuanli@126.com.
authors.forename: Yuan-Li
authors.initials: YL
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed
keywords: Cerebral angiography; Child; Intracranial arteriovenous malformation; Intracranial haemorrhage; Risk assessment