• Alexander Copelan, Gerald Drocton, M Travis Caton, Eric R Smith, Daniel L Cooke, Jeffrey Nelson, Adib A Abla, Christine Fox, Matthew R Amans, Christopher F Dowd, Van V Halbach, Randall T Higashida, Michael T Lawton, Helen Kim, Heather J Fullerton, Nalin Gupta, Steven W Hetts, and UCSF Center For Cerebrovascular Research and UCSF Pediatric Brain Center.
• Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.
• Stroke. 2020 Oct 1; 51 (10): 2990-2996.

Background And PurposeDo children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture?MethodsWe retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure.ResultsThe mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P=0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; P=0.031).ConclusionsThere is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.

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