Modifiable vascular risk factors in patients with cerebral and spinal cavernous malformations: a complete 10-year follow-up study

Steffen Rauscher, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Alejandro N. Santos, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Hanah Hadice Gull, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Laurèl Rauschenbach, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Bixia Chen, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Börge Schmidt, Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany.
Cornelius Deuschl, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Arnau Benet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ramazan Jabbarli, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Karsten H. Wrede, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Adrian M. Siegel, Department of Neurology, University of Zurich, Zurich, Switzerland.
Michael Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ulrich Sure, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Philipp Dammann, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: The aim was to investigate the effect of modifiable vascular risk factors on the risk of first and recurrent bleeding for patients with a cavernous malformation (CM) of the central nervous system (CNS) over a 10-year period. METHODS: A retrospective review of our CM institutional database was performed spanning from 2003 to 2021. The inclusion criteria were non-missing serial magnetic resonance imaging studies and clinical baseline metrics such as vascular risk factors. The exclusion criteria were patients who underwent surgical CM removal and patients with less than a decade of follow-up. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative risk (10 years) of hemorrhage. RESULTS: Eighty-nine patients with a CM of the CNS were included. Our results showed a non-significant increased risk of hemorrhage during 10 years of follow-up in patients using nicotine (hazard ratio 2.11, 95% confidence interval 0.86-5.21) and in patients with diabetes (hazard ratio 3.25, 95% confidence interval 0.71-14.81). For the presence of modifiable vascular risk factors at study baseline different cumulative 10-year risks of bleeding were observed: arterial hypertension 42.9% (18.8%-70.4%); diabetes 66.7% (12.5%-98.2%); hyperlipidemia 30% (8.1%-64.6%); active nicotine abuse 50% (24.1%-76%); and obesity 22.2% (4%-59.8%). Overall cumulative (10-year) hemorrhage risk was 30.3% (21.3%-41.1%). CONCLUSIONS: The probability of hemorrhage in untreated CNS CM patients increases progressively within a decade of follow-up. None of the modifiable vascular risk factors showed strong indication for an influence on hemorrhage risk, but our findings may suggest a more aggressive course in patients with active nicotine abuse or suffering from diabetes.

Medical Subject Headings

Humans; Follow-Up Studies; Hemangioma, Cavernous, Central Nervous System (complications, epidemiology); Nicotine; Risk Factors; Cerebral Hemorrhage (etiology); Magnetic Resonance Imaging

Publication Date

5-1-2023

Publication Title

European journal of neurology

E-ISSN

1468-1331

Volume

30

Issue

5

First Page

1346

Last Page

1351

PubMed ID

36773004

Digital Object Identifier (DOI)

10.1111/ene.15737

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