Risk of rebleeding in patients suffering from ruptured brain arteriovenous malformations undergoing subacute treatment: a single-center series and systematic review of the literature

Abstract Introduction The optimal timing for treatment of ruptured brain arteriovenous malformations (BAVM) is still controversial discussed. The present study aims to determine safety of subacute BAVM management in clinically stable patients by identifying the rate of rebleeding. Methods Patients presenting from 2000 to 2018 with ruptured BAVM who were scheduled for BAVM-treatment at least 4 weeks after initial hemorrhage were included in the present study. After neurological rehabilitation of the patient and decrease of hemorrhage-induced brain swelling, subacute treatment for the ruptured BAVM was carried out. Primary outcome of the present series was defined as treatment failure due to rehemorrhage caused by the ruptured BAVM in patients previously labeled eligible for subacute BAVM treatment. Additionally, we performed a systematic review of the contemporary peer-reviewed literature concerning treatment strategy in patients with ruptured BAVM. Results 55 patients suffering from ruptured BAVM were considered eligible for subacute BAVM treatment at our institution. No patient suffered from early rebleeding before definitive BAVM treatment in our institutional group. Our own patient data was then pooled with data from the literature resulting in 166 patients suffering from ruptured BAVM who underwent subacute BAVM treatment. Of these, one patient (0.6%) suffered from rehemorrhage during the recovery period 130 days after initial BAVM rupture. Conclusions The present series and systematic review revealed a rehemorrhage rate of 0.6% in patients suffering from ruptured BAVM who underwent subacute treatment. Therefore, subacute treatment of patients with ruptured BAVM seems safe after application of rigorous treatment algorithms in order to sort out patients with higher risk for rehemorrhage.