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Management of Ruptured Brain Arteriovenous Malformations

  • Cardiovascular Disease and Stroke (M Fink and J Safdieh, Section Editors)
  • Published:
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Abstract

Intracranial arteriovenous malformations (AVMs) are a common cause of stroke in younger patients, and often present as intracerebral hemorrhages (ICH), associated with 10 % to 30 % mortality. Patients who present with a hemorrhage from an AVM should be initially stabilized according to acute management guidelines for ICH. The characteristics of a lesion including its size, location in eloquent tissue, and high-risk features will influence risk of rupture, prognosis, as well as help guide management decisions. Given that rupture is associated with an increased risk of 6 % re-rupture in the year following the initial hemorrhage, versus 1 % to 3 % predicted annual risk in non-ruptured lesions only, definitive treatment is encouraged after ICH stabilization. A rest period of 2 to 6 weeks after hemorrhage is recommended before definitive treatment to avoid disrupting friable parenchyma and the hematoma. Treatment may consist of endovascular embolization, surgical resection, radiosurgery, or a combination of these three interventions based on the lesion.

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Acknowledgments

This work was supported by a grant from the Doris Duke Charitable Foundation to Columbia University to fund Clinical Research Fellow KAV. Source of Funding: Department of Neurological Surgery, Doris Duke Charitable Foundation

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Neurological Surgery, Columbia University, 710 West 168th St, New York, NY, 10032, USA

    Brad E. Zacharia, Kerry A. Vaughan, Adam Jacoby, Zachary L. Hickman, Daniel Bodmer & E. Sander Connolly Jr.

  2. Department of Neurological Surgery, Columbia University, 630 West 168th Street, Room 5-454, New York, NY, 10032, USA

    Brad E. Zacharia

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  1. Brad E. Zacharia
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Correspondence to Brad E. Zacharia.

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Zacharia, B.E., Vaughan, K.A., Jacoby, A. et al. Management of Ruptured Brain Arteriovenous Malformations. Curr Atheroscler Rep 14, 335–342 (2012). https://doi.org/10.1007/s11883-012-0257-9

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