SLIDE 14 Silent Microhemorrhage
Evidence of old hemorrhage 7% Index ICH, OR = 4.0 New ICH, OR = 3.5
No EOOH EOOH
“Unruptured” AVMs with silent microhemorrhage have increased natural history risk
Hemorrhage-free Survival
Silent Microhemorrhage
Will increase surgical indications for unruptured AVMs
Conclusions
- Surgery for unruptured AVMs is now considered risky
- Like ISAT for aneurysms, ARUBA will require a response (BARBADOS)
- Surgical indications remain strong for low-grade AVMs, those with silent
microhemorrhage, and some downgraded AVMs
- Embolization as preoperative adjunct (not cure)
- Radiosurgery for deep or high-risk AVMs
- Need to maintain surgical excellence through careful selection, meticulous
technique, and precise strategy
- Surgery should be considered the “gold standard”
UCSF AVM Study Project
Neurological Surgery Michael Lawton, MD Michael McDermott, MD Lisa Hannegan, CNS April Sabangan, RN Neurovascular Neurology Wade Smith, MD, PhD
- S. Claiborne Johnston, MD, PhD
Nerissa Ko, MD Andrew Josephson, MD Interventional Neuroradiology Van Halbach, MD Randall Higashida, MD Christopher Dowd, MD Center for Cerebrovascular Research William Young, MD Helen Kim, PhD Hua Su, PhD Ludmila Pawlikowska, PhD Tomoki Hashimoto, MD, PhD David Saloner, MD Etc., etc. Department of Pathology Tarik Tirhan, MD, PhD Andrew Bollen, MD, PhD
http://avm.ucsf.edu
