Modifiable vascular risk factors in patients with cerebral and spinal cavernous malformations: a complete 10-year follow-up study
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
European journal of neurology
Digital Object Identifier (DOI)
Rauscher, Steffen; Santos, Alejandro N.; Gull, Hanah Hadice; Rauschenbach, Laurèl; Chen, Bixia; Schmidt, Börge; Deuschl, Cornelius; Benet, Arnau; Jabbarli, Ramazan; Wrede, Karsten H.; Siegel, Adrian M.; Lawton, Michael; Sure, Ulrich; and Dammann, Philipp, "Modifiable vascular risk factors in patients with cerebral and spinal cavernous malformations: a complete 10-year follow-up study" (2023). Neurosurgery. 1818.