Document Detail


Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study.
MedLine Citation:
PMID:  18243054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Catherine J Wedderburn; Janneke van Beijnum; Jo J Bhattacharya; Carl E Counsell; Vakis Papanastassiou; Vaughn Ritchie; Richard C Roberts; Robin J Sellar; Charles P Warlow; Rustam Al-Shahi Salman;
Related Documents :
16819814 - The evolution of endovascular treatment for intracranial arteriovenous malformations.
2352594 - Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective...
23602084 - Monitoring of hiv viral load, cd4 cell count, and clinical assessment versus clinical m...
6188754 - Intracavitary radiation for rectal carcinoma.
20573454 - Ultrasound assessed thickness of burn scars in association with laser doppler imaging d...
24384784 - Fondaparınux versus nadroparın for preventıon of venous thromboembolısm after electıve ...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-01
Journal Detail:
Title:  The Lancet. Neurology     Volume:  7     ISSN:  1474-4422     ISO Abbreviation:  Lancet Neurol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-15     Completed Date:  2008-05-05     Revised Date:  2014-08-15    
Medline Journal Info:
Nlm Unique ID:  101139309     Medline TA:  Lancet Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  223-30     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Community Health Planning
Female
Humans
Intracranial Arteriovenous Malformations / epidemiology*,  therapy*
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Factors
Scotland / epidemiology
Severity of Illness Index
Survival Analysis
Time Factors
Grant Support
ID/Acronym/Agency:
CAF/06/30//Chief Scientist Office; CZB/4/35//Medical Research Council; CZG/2/265//Chief Scientist Office; G108/613//Medical Research Council; G84/5176//Medical Research Council; K/MRS/50/C2704//Chief Scientist Office
Investigator
Investigator/Affiliation:
J MacKenzie / ; A Murray / ; S Olson / ; O Robb / ; R Coleman / ; C Counsell / ; L Gerrie / ; G Hall / ; M-A Macleod / ; C Derry / ; R Hewett / ; E Visser / ; D Currie / ; I Fouyas / ; E Labram / ; M Shanmuganathan / ; M Macleod / ; J McLay / ; J Webster / ; S Wilkinson / ; D Williams / ; M Ablett / ; P Syme / ; L Ferrando / ; D Hardwick / ; H McRitchie / ; A Pearson / ; J Reid / ; T Shallcross / ; I Malik / ; M McMillan / ; E Lindsay / ; D Rawlings / ; J Edge / ; R England / ; F Fallahi / ; J Jackson / ; P Jennings / ; J Addison / ; S Forbat / ; K Brown / ; U Spelmeyer / ; M Aird / ; D Hill / ; P Kelly / ; D Patel / ; T Fitzgerald / ; G McKillop / ; A Coull / ; S Hart / ; G Mead / ; J C Arango / ; A Busuttil / ; G Kernbach-Wighton / ; L Buchanan / ; C Neumann / ; E Beveridge / ; R Burgul / ; R Johnstone / ; L Stewart / ; R Vallance / ; J Burns / ; P Langhorne / ; D Stott / ; J Taylor / ; F Wright / ; A Reid / ; G Roditi / ; G Lowe / ; B MacInnes / ; B Martin / ; B Yip / ; J Ballantyne / ; G Harold / ; D Edwards / ; A Forrester / ; F Gardner / ; F Lau / ; C Murch / ; A Burke / ; S Robinson / ; A Mallik / ; C Mann / ; A Russell / ; C Santosh / ; A Ramsay / ; J Bhattacharya / ; D Hadley / ; S Jenkins / ; D Kean / ; A Siddiqui / ; S Sloss / ; E Teasdale / ; L Walker / ; T Baird / ; R Duncan / ; W Durward / ; M E Farrugia / ; G Gorrie / ; J Greene / ; D Grosset / ; O Jack / ; P Kennedy / ; J Leach / ; R Metcalfe / ; K Muir / ; C O'Leary / ; J Overell / ; R Petty / ; R Thomas / ; A Tyagi / ; H Willison / ; K Brennan / ; P Connick / ; S Cooper / ; K Dani / ; S Finlayson / ; P Foley / ; V Marshall / ; S Miller / ; I Morrison / ; E Newman / ; S Razvi / ; J Reid / ; U Schultz / ; K Taylor / ; L Alankandy / ; P Barlow / ; J Brown / ; L Dunn / ; R Johnston / ; K Lindsay / ; P Littlechild / ; J St George / ; M Behebani / ; E Campbell / ; C Gavin / ; K Goyal / ; A Kumar / ; I Liaquat / ; C Mathieson / ; R Sangra / ; N Simms / ; D Walsh / ; M White / ; F Kelly / ; P Walsh / ; H Fattah / ; F Johnson / ; K Wallers / ; D Birchall / ; K Tay / ; A Gholkar / ; V Jayakrishnan / ; D Mitra / ; A Kanodia / ; G Houston / ; G Main / ; J Tainsh / ; I Zealley / ; J O'Riordan / ; R Roberts / ; R Swingler / ; V Szepielow / ; K White / ; Z Dean / ; C Heath / ; A Kivjazovas / ; P Shah / ; E Ballantyne / ; S Eljamel / ; D Mowle / ; R Elashall / ; A Doney / ; R MacWalter / ; R Murray / ; J Harper / ; S Johnston / ; I Lightbody / ; M Connor / ; G Stewart / ; H Ireland / ; N Chapman / ; J McKenzie / ; S Pound / ; P Findlay / ; J Miller / ; G Aitken / ; D Goff / ; P Henry / ; A Macleod / ; D Nichols / ; H Shannon / ; A Todd / ; A Wallace / ; L Erwin / ; D Farquhar / ; K Jackson / ; S Ramsay / ; J Wilson / ; J Stone / ; S Chambers / ; R Prempeh / ; M Macleod / ; S McCallan / ; P McDermott / ; P Fraser / ; C McAlpine / ; T Bryant / ; F Bryden / ; H Griffiths / ; A McCafferty / ; I Mcleod / ; J Shand / ; R Stevens / ; I Gillanders / ; J Tainsh / ; M Zeidler / ; S Bahnsen / ; B Reid / ; C Clark / ; V Cvoro / ; M Roberts / ; J Lauder / ; J Calder / ; A Downie / ; M Gronski / ; I McLaughlin / ; G Chohan / ; S Erridge / ; A Gregor / ; M Porteous / ; J Ironside / ; C Smith / ; G Moran / ; A Farrall / ; P Keston / ; G Potter / ; D Summers / ; D Collie / ; R Gibson / ; B Innes / ; S Kealey / ; R Sellar / ; J Wardlaw / ; P White / ; E Wood / ; R Al-Shahi Salman / ; R Davenport / ; R Grant / ; R Knight / ; C Mumford / ; P Sandercock / ; G Stewart / ; C Sudlow / ; C Warlow / ; B Weller / ; R Will / ; C Butler / ; P Fox / ; A Kelso / ; K Murray / ; D Simpson / ; W Whiteley / ; A Williams / ; F Doubal / ; M Fitzpatrick / ; L Myles / ; T Russell / ; P Statham / ; J Steers / ; I Whittle / ; H Cook / ; F Hughes / ; W Young / ; S Al-Haddad / ; C Balasubramaniyam / ; P Bodkin / ; P Brennan / ; R Dubey / ; M Dennis / ; S Keir / ; M Brodie / ; M Walters / ; K Kelly / ; E Kalkman / ; N McMillan / ; K Lees / ; G McInnes / ; J Reid / ; P Semple / ; D Alcorn / ; M Callaghan / ; M El-Sayed / ; M Fleet / ; B Macpherson / ; S Reid / ; J Roberts / ; S Hamilton / ; F Smith /
Comments/Corrections
Comment In:
Lancet Neurol. 2008 Mar;7(3):195-6   [PMID:  18243055 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Rv3134c/devR/devS operon of Mycobacterium bovis BCG is differentially transcribed under "in vitro" s...
Next Document:  Randomized trials and registries: a computer simulation to study the impact of surgeon/patient facto...