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Stroke. 2012 Nov;43(11):2910-5. doi: 10.1161/STROKEAHA.112.669945.

Persistent hemodynamic changes in ruptured brain arteriovenous malformations.

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  • 1Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.



Hemodynamic properties of brain arteriovenous malformations (AVMs) with risk factors for a future hemorrhage are essentially unknown. We hypothesized that AVMs with anatomic properties, which are associated with an increased rupture risk, exhibit different hemodynamic characteristics than those without these properties.


Seventy-two consecutive patients with AVMs diagnosed by conventional angiography underwent MRI examination, including time-resolved 3-dimensional MR angiography. Signal-intensity curves derived from the time-resolved 3-dimensional MR angiography datasets were used to calculate relative blood flow transit times through the AVM nidus based on the time-to-peak parameter. For identification of characteristics associated with altered transit times, a multiple normal regression model was fitted with stepwise selection of the following regressors: intracranial hemorrhage, deep nidus location, infratentorial location, deep drainage, associated aneurysm, nidus size, draining venous stenosis, and number of draining veins.


A previous intracranial hemorrhage is the only characteristic that was associated with a significant alteration of the relative transit time, leading to an increase of 2.4 seconds (95% CI, 1.2-3.6 seconds;, P<0.001) without adjustment and 2.1 seconds (95% CI, 0.6-3.6 seconds; P=0.007) with adjustment for all other regressors considered. The association was independent of the bleeding age.


Hemodynamic parameters do not seem useful for risk assessment of an AVM-related hemorrhage because only a previous AVM rupture leads to a significant and permanent alteration of the hemodynamic situation.

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