Re-rupture in ruptured brain arteriovenous malformations: a retrospective cohort study based on a nationwide multicenter prospective registry

作者：Kexin Yuan, Yú Chen, Debin Yan, Ruinan Li, Zhipeng Li, Haibin Zhang, Ke Wang, Heze Han, Yahui Zhao, Yahui Zhao, Li Ma, Qiang Hao, Xun Ye, Hengwei Jin, Xiangyu Meng, Ali Liu, Dezhi Gao, Shibin Sun, Shuai Kang, Hao Wang, Youxiang Li, Shuo Wang, Xiaolin Chen, Yuanli Zhao, Yuanli Zhao · 发表于：Journal of NeuroInterventional Surgery · 年份：2023 · DOI：10.1136/jnis-2023-020650 · 被引用次数：17 · 研究领域：Vascular Malformations Diagnosis and Treatment、Vascular Anomalies and Treatments、Intracranial Aneurysms: Treatment and Complications

BACKGROUND: This study aimed to investigate the natural history of re-rupture in ruptured brain arteriovenous malformations (AVMs) and to provide comprehensive insights into its associated factors and prevention. METHODS: This study included 1712 eligible ruptured AVMs from a nationwide multicenter prospective collaboration registry between August 2011 and September 2021. The natural rupture risk before intervention and the annual rupture risk after intervention were both assessed. Cox proportional hazard regression models and Kaplan-Meier survival curves were used to explore independent factors associated with AVM re-rupture. The correlation between these factors and AVM re-rupture was verified in multiple independent cohorts, and the prevention effect of intervention timing and intervention strategies on AVM re-rupture was further analyzed. RESULTS: The annual re-rupture risk in ruptured AVMs was 7.6%, and the cumulative re-rupture risk in the first 1, 3, 5, and 10 years following the initial rupture were 10%, 25%, 37.5%, and 50%, respectively. Cox proportional hazard regression analysis confirmed adult patients, ventricular system involvement, and any deep venous drainage as independent factors associated with AVM re-rupture. The intervention was found to significantly reduce the risk of AVM re-rupture (annual rupture risk 11.34% vs 1.70%, p<0.001), especially in those who underwent surgical resection (annual rupture risk 0.13%). CONCLUSIONS: The risk of re-rupture in rupt...