BACKGROUND: The mechanisms and management of delayed intracerebral hemorrhage (dICH) after treatment of brain arteriovenous malformations (AVMs) are poorly understood and widely debated. Many clinical predictive factors have been theorized for dICH following an otherwise uneventful AVM embolization, but there is an absence of data to discern their significance.
OBJECTIVE: To analyze 13 proposed predictive factors and assess their potential in guiding prevention strategies.
METHODS: 168 embolization procedures were performed on 67 patients with brain AVMs by a single surgeon. Patients were divided into two groups: those with symptomatic dICH and controls. Thirteen factors were analyzed: age, sex, race, previous ICH, Spetzler-Martin grade, AVM size, eloquence, embolic volume, embolic agent, percent obliteration,and timing, number, and stage of embolizations. Univariate and multivariate analysis were performed on these factors to determine significance.
RESULTS: Six procedures were complicated by dICH; five (83%) occurred after the final planned procedure. The volume of embolic agent was significantly higher in the dICH group (4.5ml +/- 1.0) compared to controls (1.7ml +/- 0.2) using both univariate and multivariate analysis (P < 0.01), even after controlling for size of AVMs. AVM size was significant using univariate analysis, but not with multivariate analysis. There were no statistically significant differences between the groups when considering any of the other possible predictive factors.
CONCLUSION: High volume of embolic agent administered per procedure is an independent predictive factor for dICH. Limiting the injected volume for each procedure may reduce this poorly understood complication.
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