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Observational Study
. 2020 Oct 13;10(10):e036606.
doi: 10.1136/bmjopen-2019-036606.

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

Cien-Leong Chye  1   2 , Kuo-Wei Wang  1   3 , Han-Jung Chen  1   2 , Shyh-An Yeh  1   4 , James Taoqian Tang  1   5 , Cheng-Loong Liang  6   2
Affiliations
Observational Study

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

Cien-Leong Chye et al. BMJ Open. .

Abstract

Objectives: The present nationwide population-based cohort study aims to assess the effectiveness of gamma knife radiosurgery (GKS) on ruptured and unruptured brain arteriovenous malformations (AVMs) by evaluating the haemorrhage rates.

Design: A nationwide, retrospective cohort study.

Setting: Taiwan National Health Insurance Research Database (NHIRD).

Participants: An observational study of 1515 patients who were diagnosed with brain AVMs between 1997 and 2013 from the Taiwan NHIRD.

Primary outcome and secondary outcome measures: We performed a survival analysis using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to explore the relationship between treatment modalities (GKS vs non-GKS) and haemorrhage, adjusted for age and sex.

Results: The GKS and non-GKS groups included 317 and 1198 patients, respectively. Patients in the GKS group (mean±SD, 33.08±15.48 years of age) tended to be younger than those in the non-GKS group (37.40±17.62) (p<0.001). The 15-year follow-up revealed that the rate of bleeding risk was lower in the GKS group than in the non-GKRS group (adjusted HR (aHR) 0.61; 95% CI 0.40 to 0.92). The bleeding risk of ruptured AVMs was significantly lower in GKS group than in the non-GKS group (aHR 0.34; 95% CI 0.19 to 0.62). On the other hand, the bleeding risk of unruptured AVMs was higher in the GKS group than in the non-GKS group (aHR 1.95; 95% CI 1.04 to 3.65). In the unruptured AVM group, the incidence of bleeding was significantly higher among patients in the GKS group that were of >40 years of age (aHR 3.21; 95% CI 1.12 to 9.14).

Conclusions: GKS is safe and it reduces the risk of haemorrhage in patients with ruptured AVMs. The administration of GKS to patients with unruptured AVMs who are above the age of 40 years old male might increase the risk of haemorrhage.

Keywords: neurosurgery; stroke; stroke medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The flow chart of the cohort in this study. GKS, gamma knife radiosurgery.
Figure 2
Figure 2
Kaplan-Meier curves showing cumulative rates of haemorrhage in ruptured AVM patients in relation to treatment modalities (non-GKS group vs GKS group) and age: (A) age <20, (B) age between 20 and 40, (C) age >40 years. AVM, arterovenous malformation; GKS, gamma knife radiosurgery; ICH, intrcerebralhaemorrhage.
Figure 3
Figure 3
Kaplan-Meier curves showing cumulative rates of haemorrhage in unruptured AVM patients in relation to treatment modalities (non-GKS group vs GKS group) and age: (A) age <20, (B) age between 20 and 40, (C) age >40 years. AVM, arterovenous malformation; GKS, gamma knife radiosurgery; ICH, intrcerebralhaemorrhage.
See this image and copyright information in PMC

References

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