Frequency of Vasospasm Due to Ruptured Brain Arteriovenous Malformation in Patients Older Than 18 Years Between 2010 and 2022: A Systematic Review

Introduction: Cerebral vasospasm (CV) has been identified as a relevant cause of mortality and neurological morbidity in aneurysmal subarachnoid hemorrhage. Although brain arteriovenous malformations (bAVMs) are the second cause of spontaneous subarachnoid hemorrhage (SAH), information about the occurrence of CV in ruptured bAVMs is scarce. Our aim is to establish the frequency and risk factors of CV following ruptured bAVMs in patients over 18 years of age in the latest 12 years.

Methods: According to Joanna Briggs Institute´s guidelines, a systematic review was performed inquiring PubMed, Lilacs, and Scopus databases with the following MESH terms: Intracranial Arteriovenous Malformations, ruptured, vasospasm, epidemiology. The risk of bias was evaluated using Grade Pro. Patients from manuscripts between 2010 and 2022 aged 18 years, with ruptured bAVMs, and diagnosis of vasospasm by transcranial doppler or digital subtraction angiography were included.

Results: A total of 6 articles were included with a population of 7772 patients with ruptured bAVMs. The median age was 43 years (IQR 42.3-43.8). CV occurred in 964 patients (12.4 %), of which 601 (62.3%) were women. Delayed cerebral ischemia was described in 123 cases (1.5%). The mean time between bleeding and CV was 7.8 days (CI 95% 6.78-8.98). In the group of patients with CV, 708, 252, and 188 corresponded to SAH, intraparenchymal hemorrhage, and intraventricular hemorrhage, respectively. Treatment for vasospasm was reported in 13 patients (1.3%), with intravenous nimodipine, intra-arterial nimodipine, and intra-arterial verapamil in 4, 8, and 1 patients, respectively. Low GCS at admission (per unit decrease) (OR: 1.38, P: 0.005), young age (per 10-year decrease) (OR: 1.39, P: 0.01), and female gender (OR: 4.86, P: 0,04), were identified as risk factors for CV.

Conclusion : The frequency of CV in AVMs is not negligible. Future studies are needed to reach a management consensus according to risk stratification.