{"id":"2fb39518-1e79-4502-b1a5-af1ec345a4ad","slug":"a-proposed-classification-for-assessing-rupture-risk-in-patients-with-intracranial-arteriovenous-malformations","title":"A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations","authors":["Felipe Padilla-Vazquez","Marco A. Zenteno","Jorge Balderrama","Victor Hugo Escobar-de la Garma","Daniel San Juan","Carlos Trenado"],"abstract":"Background: Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs. Methods: This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1–4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis. Results: A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061–0.188), 2 point OR = (0.227 95% CI; 0.153–0.338), 3 point OR = (3.292 95% CI; 2.325–4.661), and 4 point OR = (23.304 95% CI; 11.077–49.027). Conclusion: This classification is useful and easy to use, and it may allow for the individualisation of each cerebral AVM and the assessment of rupture risk based on a model of categorisation.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/2fb39518-1e79-4502-b1a5-af1ec345a4ad/featured/hero-1782420789936.png","publishDate":"2017-12-27T00:00:00.000Z","doi":"10.4103/sni.sni_273_17","categories":["Neurovascular","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2018/01/8706/SNI-8-303.pdf"}