Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study
Summary Background The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had i...
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| Veröffentlicht in: | Lancet neurology 2008-03, Vol.7 (3), p.223-230 |
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| creator | Wedderburn, Catherine J, BA van Beijnum, Janneke, MD Bhattacharya, Jo J, FRCR Counsell, Carl E, MRCP Papanastassiou, Vakis, FRCS[SN] Ritchie, Vaughn, MB Roberts, Richard C, FRCP Sellar, Robin J, FRCR Warlow, Charles P, FRCP Al-Shahi Salman, Rustam, FRCP Edin |
| description | Summary Background The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not. Methods All adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51). Findings At presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p |
| doi_str_mv | 10.1016/S1474-4422(08)70026-7 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70292049</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1474442208700267</els_id><sourcerecordid>70292049</sourcerecordid><originalsourceid>FETCH-LOGICAL-c511t-ef54242d3a6bfbcc52c3f7aa12b2a304a4dd942c10b445bb99ffc4fdb4fc93963</originalsourceid><addsrcrecordid>eNqFkc2OFCEUhStG4_zoI2iIC6OJpUBBVZcLzWTiXzLJLNQ1AeqijFVQQtFJP4jv663uzpjMxg2Qyzkf3Huq6gmjrxll7ZuvTHSiFoLzF3TzsqOUt3V3rzo9llt5__bM-Ul1lvMNapjYsIfVCdtw0VApTqs_12WxcQKi3QKJ-IDrFsLiY9AjiYnYGDKW9OK3QCYd9A-Y8J5ER0pIZV5KgoGYpH0gOqHbR_THklE8upgmvbLyW6LJnGKewa6kV2SOcxn3d7XRGRE2_oxpIXkpw-5R9cDpMcPj435eff_44dvl5_rq-tOXy4ur2krGlhqcFFzwodGtccZayW3jOq0ZN1w3VGgxDL3gllEjhDSm752zwg1GONs3fducV88PXPza7wJ5UZPPFsZRB8AWVEd5z6noUfjsjvAmloQjyopTHKqUskORPIgsNpoTODUnP-m0U4yqNTS1D02tiSi6UfvQ1Op7eoQXM8Hwz3VMCQXvDwLAWWw9JJWth2Bh8AnnqYbo__vEuzsEO_rgrR5_wQ7ybTNMZfQdICuDbvaErvkLlR3Aqw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>201485557</pqid></control><display><type>article</type><title>Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Wedderburn, Catherine J, BA ; van Beijnum, Janneke, MD ; Bhattacharya, Jo J, FRCR ; Counsell, Carl E, MRCP ; Papanastassiou, Vakis, FRCS[SN] ; Ritchie, Vaughn, MB ; Roberts, Richard C, FRCP ; Sellar, Robin J, FRCR ; Warlow, Charles P, FRCP ; Al-Shahi Salman, Rustam, FRCP Edin</creator><creatorcontrib>Wedderburn, Catherine J, BA ; van Beijnum, Janneke, MD ; Bhattacharya, Jo J, FRCR ; Counsell, Carl E, MRCP ; Papanastassiou, Vakis, FRCS[SN] ; Ritchie, Vaughn, MB ; Roberts, Richard C, FRCP ; Sellar, Robin J, FRCR ; Warlow, Charles P, FRCP ; Al-Shahi Salman, Rustam, FRCP Edin ; on behalf of the SIVMS Collaborators ; SIVMS Collaborators</creatorcontrib><description>Summary Background The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not. Methods All adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51). Findings At presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up. Interpretation Greater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.</description><identifier>ISSN: 1474-4422</identifier><identifier>EISSN: 1474-4465</identifier><identifier>DOI: 10.1016/S1474-4422(08)70026-7</identifier><identifier>PMID: 18243054</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aneurysms ; Catheters ; Cohort analysis ; Cohort Studies ; Community Health Planning ; Convulsions & seizures ; Female ; Humans ; Intracranial Arteriovenous Malformations - epidemiology ; Intracranial Arteriovenous Malformations - therapy ; Male ; Medical imaging ; Medical records ; Middle Aged ; Neuroimaging ; Neurology ; Population ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Scotland - epidemiology ; Severity of Illness Index ; Stroke ; Survival Analysis ; Time Factors</subject><ispartof>Lancet neurology, 2008-03, Vol.7 (3), p.223-230</ispartof><rights>Elsevier Ltd</rights><rights>2008 Elsevier Ltd</rights><rights>Copyright Elsevier Limited Mar 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-ef54242d3a6bfbcc52c3f7aa12b2a304a4dd942c10b445bb99ffc4fdb4fc93963</citedby><cites>FETCH-LOGICAL-c511t-ef54242d3a6bfbcc52c3f7aa12b2a304a4dd942c10b445bb99ffc4fdb4fc93963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1474442208700267$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18243054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wedderburn, Catherine J, BA</creatorcontrib><creatorcontrib>van Beijnum, Janneke, MD</creatorcontrib><creatorcontrib>Bhattacharya, Jo J, FRCR</creatorcontrib><creatorcontrib>Counsell, Carl E, MRCP</creatorcontrib><creatorcontrib>Papanastassiou, Vakis, FRCS[SN]</creatorcontrib><creatorcontrib>Ritchie, Vaughn, MB</creatorcontrib><creatorcontrib>Roberts, Richard C, FRCP</creatorcontrib><creatorcontrib>Sellar, Robin J, FRCR</creatorcontrib><creatorcontrib>Warlow, Charles P, FRCP</creatorcontrib><creatorcontrib>Al-Shahi Salman, Rustam, FRCP Edin</creatorcontrib><creatorcontrib>on behalf of the SIVMS Collaborators</creatorcontrib><creatorcontrib>SIVMS Collaborators</creatorcontrib><title>Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study</title><title>Lancet neurology</title><addtitle>Lancet Neurol</addtitle><description>Summary Background The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not. Methods All adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51). Findings At presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up. Interpretation Greater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysms</subject><subject>Catheters</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Community Health Planning</subject><subject>Convulsions & seizures</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial Arteriovenous Malformations - epidemiology</subject><subject>Intracranial Arteriovenous Malformations - therapy</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Population</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Scotland - epidemiology</subject><subject>Severity of Illness Index</subject><subject>Stroke</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><issn>1474-4422</issn><issn>1474-4465</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc2OFCEUhStG4_zoI2iIC6OJpUBBVZcLzWTiXzLJLNQ1AeqijFVQQtFJP4jv663uzpjMxg2Qyzkf3Huq6gmjrxll7ZuvTHSiFoLzF3TzsqOUt3V3rzo9llt5__bM-Ul1lvMNapjYsIfVCdtw0VApTqs_12WxcQKi3QKJ-IDrFsLiY9AjiYnYGDKW9OK3QCYd9A-Y8J5ER0pIZV5KgoGYpH0gOqHbR_THklE8upgmvbLyW6LJnGKewa6kV2SOcxn3d7XRGRE2_oxpIXkpw-5R9cDpMcPj435eff_44dvl5_rq-tOXy4ur2krGlhqcFFzwodGtccZayW3jOq0ZN1w3VGgxDL3gllEjhDSm752zwg1GONs3fducV88PXPza7wJ5UZPPFsZRB8AWVEd5z6noUfjsjvAmloQjyopTHKqUskORPIgsNpoTODUnP-m0U4yqNTS1D02tiSi6UfvQ1Op7eoQXM8Hwz3VMCQXvDwLAWWw9JJWth2Bh8AnnqYbo__vEuzsEO_rgrR5_wQ7ybTNMZfQdICuDbvaErvkLlR3Aqw</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>Wedderburn, Catherine J, BA</creator><creator>van Beijnum, Janneke, MD</creator><creator>Bhattacharya, Jo J, FRCR</creator><creator>Counsell, Carl E, MRCP</creator><creator>Papanastassiou, Vakis, FRCS[SN]</creator><creator>Ritchie, Vaughn, MB</creator><creator>Roberts, Richard C, FRCP</creator><creator>Sellar, Robin J, FRCR</creator><creator>Warlow, Charles P, FRCP</creator><creator>Al-Shahi Salman, Rustam, FRCP Edin</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8C2</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20080301</creationdate><title>Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study</title><author>Wedderburn, Catherine J, BA ; van Beijnum, Janneke, MD ; Bhattacharya, Jo J, FRCR ; Counsell, Carl E, MRCP ; Papanastassiou, Vakis, FRCS[SN] ; Ritchie, Vaughn, MB ; Roberts, Richard C, FRCP ; Sellar, Robin J, FRCR ; Warlow, Charles P, FRCP ; Al-Shahi Salman, Rustam, FRCP Edin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-ef54242d3a6bfbcc52c3f7aa12b2a304a4dd942c10b445bb99ffc4fdb4fc93963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysms</topic><topic>Catheters</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Community Health Planning</topic><topic>Convulsions & seizures</topic><topic>Female</topic><topic>Humans</topic><topic>Intracranial Arteriovenous Malformations - epidemiology</topic><topic>Intracranial Arteriovenous Malformations - therapy</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Population</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Scotland - epidemiology</topic><topic>Severity of Illness Index</topic><topic>Stroke</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wedderburn, Catherine J, BA</creatorcontrib><creatorcontrib>van Beijnum, Janneke, MD</creatorcontrib><creatorcontrib>Bhattacharya, Jo J, FRCR</creatorcontrib><creatorcontrib>Counsell, Carl E, MRCP</creatorcontrib><creatorcontrib>Papanastassiou, Vakis, FRCS[SN]</creatorcontrib><creatorcontrib>Ritchie, Vaughn, MB</creatorcontrib><creatorcontrib>Roberts, Richard C, FRCP</creatorcontrib><creatorcontrib>Sellar, Robin J, FRCR</creatorcontrib><creatorcontrib>Warlow, Charles P, FRCP</creatorcontrib><creatorcontrib>Al-Shahi Salman, Rustam, FRCP Edin</creatorcontrib><creatorcontrib>on behalf of the SIVMS Collaborators</creatorcontrib><creatorcontrib>SIVMS Collaborators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Lancet Titles</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Lancet neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wedderburn, Catherine J, BA</au><au>van Beijnum, Janneke, MD</au><au>Bhattacharya, Jo J, FRCR</au><au>Counsell, Carl E, MRCP</au><au>Papanastassiou, Vakis, FRCS[SN]</au><au>Ritchie, Vaughn, MB</au><au>Roberts, Richard C, FRCP</au><au>Sellar, Robin J, FRCR</au><au>Warlow, Charles P, FRCP</au><au>Al-Shahi Salman, Rustam, FRCP Edin</au><aucorp>on behalf of the SIVMS Collaborators</aucorp><aucorp>SIVMS Collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study</atitle><jtitle>Lancet neurology</jtitle><addtitle>Lancet Neurol</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>7</volume><issue>3</issue><spage>223</spage><epage>230</epage><pages>223-230</pages><issn>1474-4422</issn><eissn>1474-4465</eissn><coden>LANCAO</coden><abstract>Summary Background The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not. Methods All adults in Scotland who were first diagnosed with an unruptured AVM during 1999–2003 (n=114) entered our prospective, population-based study. We compared the baseline characteristics and 3-year outcome of adults who received interventional treatment for their AVM (n=63) with those who did not (n=51). Findings At presentation, adults who were treated were younger (mean 40 vs 55 years of age, 95% CI for difference 9–20; p<0·0001), more likely to present with a seizure (odds ratio 2·4, 95% CI 1·1–5·0), and had fewer comorbidities (median 3 vs 4, p=0·03) than those who were not treated. Despite these baseline imbalances, treated and untreated groups did not differ in progression to Oxford Handicap Scale (OHS) scores of 2–6 (log-rank p=0·12) or 3–6 (log-rank p=0·98) in survival analyses. In a multivariable Cox proportional hazards analysis, the risk of poor outcome (OHS 2–6) was greater in patients who had interventional treatment than in those who did not (hazard ratio 2·5, 95% CI 1·1–6·0) and was greater in patients with a larger AVM nidus (hazard ratio 1·3, 95% CI 1·1–1·7). The treated and untreated groups did not differ in time to an OHS score of 2 or more that was sustained until the end of the third year of follow-up, or in the spectrum of dependence as measured by the OHS at 1, 2, and 3 years of follow-up. Interpretation Greater AVM size and interventional treatment were associated with worse short-term functional outcome for unruptured AVMs, but the longer-term effects of intervention are unclear.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>18243054</pmid><doi>10.1016/S1474-4422(08)70026-7</doi><tpages>8</tpages></addata></record> |
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| ispartof | Lancet neurology, 2008-03, Vol.7 (3), p.223-230 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Aneurysms Catheters Cohort analysis Cohort Studies Community Health Planning Convulsions & seizures Female Humans Intracranial Arteriovenous Malformations - epidemiology Intracranial Arteriovenous Malformations - therapy Male Medical imaging Medical records Middle Aged Neuroimaging Neurology Population Proportional Hazards Models Retrospective Studies Risk Factors Scotland - epidemiology Severity of Illness Index Stroke Survival Analysis Time Factors |
| title | Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study |
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