PT - JOURNAL ARTICLE AU - L. Garzelli AU - E. Shotar AU - T. Blauwblomme AU - N. Sourour AU - Q. Alias AU - S. Stricker AU - B. Mathon AU - M. Kossorotoff AU - F. Gariel AU - N. Boddaert AU - F. Brunelle AU - P. Meyer AU - O. Naggara AU - F. Clarençon AU - G. Boulouis TI - Risk Factors for Early Brain AVM Rupture: Cohort Study of Pediatric and Adult Patients AID - 10.3174/ajnr.A6824 DP - 2020 Oct 29 TA - American Journal of Neuroradiology 4099 - http://www.ajnr.org/content/early/2020/10/29/ajnr.A6824.short 4100 - http://www.ajnr.org/content/early/2020/10/29/ajnr.A6824.full AB - BACKGROUND AND PURPOSE: Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life.MATERIALS AND METHODS: Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture.RESULTS: Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P < .001), with a larger nidus (24.2  versus 18.9 mm, P = .002), were less frequently nidal (15.9% versus 23.5%, P = .03) and arterial aneurysms (2.7% versus 17.9%, P < .001), and had similar drainage patterns or Spetzler-Martin grades. In the fully adjusted Cox model, supratentorial, deep brain AVM locations (adjusted relative risk, 1.19; 95% CI, 1.01–1.41; P = .03 and adjusted relative risk, 1.43; 95% CI, 1.22–1.67; P < .001, respectively) and exclusively deep venous drainage (adjusted relative risk, 1.46, 95% CI, 1.21–1.76; P < .001) were associated with earlier rupture, whereas arterial or nidal aneurysms were associated with rupture later in life.CONCLUSIONS: The angioarchitecture of ruptured brain AVMs significantly varies across the life span. These distinct features may help to guide treatment decisions for patients with unruptured AVMs.HRhazard ratio