Cerebral vasospasm following arteriovenous malformation rupture: a population-based longitudinal study.

Vasospasm occurred in 3.0% and 30-day mortality occurred in 5.3% of adult patients with ruptured AVMs.

• Among 10,375 patients with ruptured AVMs, 297 (3.0%) experienced vasospasm in the first 30 days.
• 523 (5.3%) died within the first 30 days.
• Data were drawn from the TriNetX Research Network using ICD-10 codes over a 20-year period.
• Outcomes were assessed in the first 30 days following rupture.

Vasospasm following AVM rupture was associated with significantly increased mortality at three months, six months, and one year.

• After matching for age and sex, vasospasm was associated with increased mortality at three months (11.1% vs. 4.8%, p = 0.003).
• Mortality at six months was 12.6% vs. 5.1% (p = 0.001) for patients with vs. without vasospasm.
• Mortality at one year was 13.5% vs. 6.9% (p = 0.005) for patients with vs. without vasospasm.
• Vasospasm was associated with a more than twofold increase in mortality at both 30 days and one year.

The greatest risk factors for vasospasm within 30 days present on admission were subarachnoid hemorrhage, hydrocephalus, and leukocytosis.

• Subarachnoid hemorrhage was associated with vasospasm with a hazard ratio of 6.086 (p < 0.001).
• Hydrocephalus was associated with vasospasm with a hazard ratio of 3.783 (p < 0.001).
• Leukocytosis was associated with vasospasm with a hazard ratio of 2.0677 (p < 0.001).
• These risk factors were identified using Cox proportional hazard models adjusting for age, sex, comorbidities, substance use history, presenting factors, NIS-SSS criteria, and location of hemorrhage.

Female sex was protective against vasospasm within 30 days following AVM rupture.

• Female sex was associated with a hazard ratio of 0.714 for vasospasm (p = 0.007).
• Conversely, male sex was identified as a risk factor for vasospasm.
• Cox proportional hazard models were used to assess this association, adjusting for multiple covariates.

The greatest risk factors for 30-day mortality following AVM rupture were coma, hydrocephalus, and chronic kidney disease.

• Coma was associated with 30-day mortality with a hazard ratio of 3.700 (p < 0.001).
• Hydrocephalus was associated with 30-day mortality with a hazard ratio of 2.698 (p < 0.001).
• Chronic kidney disease was associated with 30-day mortality with a hazard ratio of 1.596 (p = 0.003).
• These associations were identified using Cox proportional hazard models adjusting for age, sex, comorbidities, substance use history, presenting factors, and hemorrhage location.