Demographic and Angioarchitectural features associated with Brain Arteriovenous Malformations Hemorrhagic Presentation, in South Africa

Background: Intracerebral hemorrhage (ICH) represents 10% of all strokes and 2% of spontaneous ICH are due to ruptured Brain Arteriovenous Malformations (BAVMs). The morbidity and mortality associated with AVM hemorrhage is as high as 35 and 10%, respectively. This study aimed to investigate the association between specific angioarchitectural features, demographic variables and hemorrhagic presentation of BAVMs. Methods: We conducted a retrospective observational chart review of all consecutive patients who presented with brain AVMs in KwaZulu-Natal, South Africa, over a period of 10 years. The demographic and clinical presentations were derived from patient’s electronic medical record; Soarian® [Siemens Healthcare GmbH, Erlanger, Bavaria, Germany]. Radiological features were determined using axial Computerized Topography (CT) or Magnetic Resonance Imaging (MRI) Scan. Angioarchitectural features were determined from Digital Subtraction Angiography (DSA). Simple and multiple logistic regression models were used to identify factors associated with brain AVM hemorrhage. Results: This study identified 157 patients with brain AVMs. Seventy-one (45%) patients presented with hemorrhage. Statistical analysis found deep AVM location (OR = 3.3; 95%CI: 1.4−7.7), exclusive deep venous drainage (OR = 3.3; 95%CI: 1.1–9.9) and presence of aneurysms (OR = 3.4; 95%CI: 1.4–7.9) to be significant predictors of brain AVM hemorrhage. Conclusion: The significant morbidity and mortality associated with brain AVMs hemorrhage behooves us to identify features that predispose these lesions to bleed. These angioarchtectural features may serve as therapeutic targets to reduce the risks of brain AVM hemorrhage.