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- W2895841958 abstract "Introduction: Invasive interventions are commonly used to prevent re-rupture of ruptured arteriovenous malformations (AVMs), but are controversial for managing unruptured AVMs. This study uses a retrospective design to identify influential factors and outcomes in our multimodal treatment program for AVMs following a first rupture. Methods: We reviewed data from a single institution for 89 patients aged 18 years or older, with a first intracranial hemorrhage due to untreated AVMs between 2002 and 2015. We analyzed patient-specific variables and initial modified Rankin Scale (mRS) score groups (A, 0-2; B, 3-5) to compare group differences. Group outcomes were also assessed via multivariate regression. Results: Locations of Hemorrhage were as follows: 43 (48.3%) intraparenchymal, 16 (18.0%) intraventricular, 6 (6.7%) subarachnoid, and 24 (27.0%) combined. Spetzler-Martin grades included 50 grade I/II, 26 grade III, and 13 grade IV/V AVMs. Interventions were utilized in 79 patients (20 surgical resection, 28 Gamma Knife surgery [GKS], and 31 combined with embolization), and conservative management in 10. Mean follow-up was 77.2±45.4 months. Peri-interventional morbidity was 5.1% and the mortality rate was zero. Re-bleeding was observed in 2 patients before intervention and 3 patients after GKS. The group A (N=69) was significantly younger (44.1±16.7 vs. 53.3±13.1, P=0.02), more likely to have a nidus fed by a perforator (30.4% vs. 5.3%, P=0.02), and more likely to undergo GKS with or without embolization (56.5% vs. 25.5%, P=0.01) than the group B (N=19). Significantly more patients in the group A had final mRS scores ≤2 than the group B (95.5% vs. 36.8%, P<0.0001). Multivariate analyses indicated that a nidus fed by a perforator was the only independent pre-hemorrhagic factor for an initial mRS 0-2, which was the only independent pre-treatment factor for a good outcome. Conclusion: Although our treatment results seemed favorable, initial severity influenced the outcome after an untreated AVM-related first intracranial hemorrhage. Further analyses of the factors associated with severe hemorrhage of AVMs may improve both the outcome of ruptured AVMs and the management of unruptured AVMs." @default.
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- W2895841958 date "2018-01-22" @default.
- W2895841958 modified "2023-09-27" @default.
- W2895841958 title "Abstract TMP99: Assessment of Management and Outcomes of a First Hemorrhage in Patients With Untreated Arteriovenous Malformations" @default.
- W2895841958 doi "https://doi.org/10.1161/str.49.suppl_1.tmp99" @default.
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