Detection of Predictors of Hemorrhage in Patients with Cerebral Arteriovenous Malformation by Digital Subtraction Angiography

Abstract

Background: Cerebral arteriovenous malformation (AVM) is a complex tangled of dilated blood vessels in which arteries flow directly into veins without capillaries. The main cause of death in patients with cerebral AVM is intraparenchymal hemorrhage. There are multiple imaging tools that can detect the predictors of hemorrhage in cerebralarteriovenous malformation. But nowadays digital subtraction angiography (DSA) is playing a wonderful role to detect these predictors.

Objectives: To detect the common predicting factors of hemorrhage from in brain by DSA. Methodology:This observational cross-sectional study was carried out in the department of Neurosurgery, Dhaka Medical College Hospital and study period was from October, 2014 to March, 2016. 76 patients of hemorrhagic stroke with clinical and radiological (CT scan) suspicion of ruptured cerebral AVM were selected by non-probability purposive sampling technique. After that enrolled patients were scrutinized according to selection criteria. Finally selected 50 patients who underwent DSA and were positive for AVM were included in this study. All the included patients’ demographic, clinical and DSA profile were recorded in pre-structured data collection sheet. All the data were compiled, edited and plotted in tabular and figure forms. Data analysis was done by chi-square test. P value was determined significant when it was <0.05.

Results: In angiographic presentation, maximum cases were found deep seated (72%), small sized (<3 cm) (70%), having compact type of nidus (58%), having superficial arterial feeder (62%), having high flow draining vein (70%), having deep venous drainage (56%) and single draining vein (78%). Associated aneurysm and venous ectasia were 12% and 4% respectively. The statistically significant predictors were deep location (P=0.036) and superficial arterial feeder (P=0.03) between male and female subjects.

Conclusion: Our results showed that small sized, deep-seated Cerebral arteriovenous malformation, having high flow draining vein, having deep venous drainage and single number of draining vein are the possible causes of hemorrhage. Lesions that have associated aneurysms have a risk of bleeding.

Bang. J Neurosurgery 2019; 8(2): 87-92