Angioarchitectural Characteristics of Brain Arteriovenous Malformations with and without Hemorrhage

OBJECTIVE: To explore angioarchitectural features of brain arteriovenous malformations (AVMs) manifesting with hemorrhage and without hemorrhage. METHODS: During the period 1999-2008, 302 consecutive patients with AVMs were retrospectively reviewed. Univariate and multivariate logistic analysis was used to assess AVM characteristics in patients who presented with hemorrhage and patients who presented without hemorrhage. Annual and cumulative incidence rates of AVM rupture were analyzed using Kaplan-Meier life-table analyses. RESULTS: The annual risk of hemorrhage from AVMs in this study was 1.9%. In the comparison of 159 patients with AVM with hemorrhage at initial presentation with 143 patients who did not experience hemorrhage initially (total 302 patients), deep and infratentorial AVM location, AVM size < 3 cm, single arterial feeder, single draining vein, combined deep and superficial drainage, presence of varices in the venous drainage, and coexisting aneurysms were statistically associated with hemorrhage presentation (P = 0.000, P = 0.000, P = 0.007, P = 0.000, P = 0.000, P = 0.000, and P = 0.003) in univariate analysis. Deep and infratentorial AVM location, single draining vein, presence of varices in the venous drainage, and coexisting aneurysms were statistically associated with hemorrhage occurrence (P = 0.007, P = 0.008, P = 0.018, and P = 0.002) in multivariate logistic analysis. CONCLUSIONS: The angioarchitectural characteristics of AVM associated with hemorrhage include deep and infratentorial AVM location, AVM size < 3 cm, single arterial feeder, single draining vein, combined deep and superficial drainage, presence of varices in the venous drainage, and coexisting aneurysms.