PREDICTORS OF SPONTANEOUS CEREBRAL AVM HEMORRHAGE

治疗脑动静脉畸形的主要原因 是预防颅内出血(ICH)。然而， 动静脉动静脉畸形的手术、栓塞和/或放射外科治疗 这是一个巨大的风险。更新的证据表明，独特的自然 历史分组显示在AVM的一般标题下。这 该项目代表了一个三管齐下的研究计划。成就 这些目标可能会给治疗内科医生和外科医生带来理性 降低发病率和更具成本效益的决策的基础 在动静脉畸形患者中。 具体目标I是一项基于单中心的出血性风险研究 (IA)界定自发性脑出血的因素，并检验以下假设 高供血动脉压和纯深静脉引流是 出血的最强预测因素；以及(Ib)延长正在进行的 首次出血后新发或复发出血的前瞻性研究 演示文稿。我们将测试后续AVM的假设 出血与最初的出血性表现有关。 疾病。这一目标将进一步将出血性表现定义为 风险，继发性出血的因素，也建立了关键的 假设(Ia)复发性脑出血与病理生理有关 在最初的陈述中，他是非物质文化遗产。 特殊目的II是一种以人群为基础的研究自发性动静脉畸形的方法 扩大我们的研究结果在特定情况下的适用性 瞄准Ib.在这项纽约群岛AVM研究中，参与 这些机构包括来自曼哈顿、斯塔滕岛、皇后区和 布鲁克林；以及长岛上的拿骚和萨福克县(人口 一针见血。1996年估计为8800,000人)。 对于具体目标III，我们建议开发和测试 一种基于风险的分配算法(也称为保证分配) 用于临床试验，使用从特定目标获得的信息 I和II。这种随机临床试验的新替代方案， 在回顾研究中成功测试，以前从未进行过 用于临床干预试验。我们希望通过以下方式进行演示 开发一种统计模型，即基于风险的分配方法 是一个可行的战略，作为建设多中心的基础 (可能是跨国)临床试验。

The primary reason to treat cerebral arteriovenous malformations (AVMs) is the prophylaxis against intracranial hemorrhage (ICH). However, treatment of AVMs by surgery, embolization and/or radiosurgery carries a significant risk. Newer evidence suggests that distinct natural history sub-groups are present under the general heading of AVM . This project represents a three-pronged plan of research. The accomplishment of these aims could bring to treating physicians and surgeons a rational basis for decreasing morbidity and more cost-effective decision-making in patients with AVMs. Specific Aim I is a single-center-based study of hemorrhagic risk to (Ia) define factors for spontaneous ICH and to test the hypothesis that high feeding artery pressure and exclusively-deep venous drainage are the strongest predictors for hemorrhage; and to (Ib) extend the ongoing prospective study of new or recurrent hemorrhage after initial presentation. We will test the hypothesis that subsequent AVM hemorrhage is related to initial hemorrhagic presentation of the disease. This aim will further define hemorrhagic presentation as a risk, factor for subsequent bleeding, and also establishes the critical assumption for (Ia) that recurrent ICH is related to the pathophysiology of ICH at initial presentation. Specific Aim II is a population-based approach to study spontaneous AVM hemorrhage to broaden the applicability of our findings under Specific Aim Ib. In this New York Islands AVM study, participating institutions include those from Manhattan, Staten Island, Queens and Brooklyn; and Nassau and Suffolk Counties on Long Island (population of aprox. 8,800,000 by 1996 estimates). For Specific Aim III we propose to develop and test the feasibility of a risk-based allocation algorithm (also called assured allocation) for use in clinical trials using information gained from Specific Aims I and II. This novel alternative to a randomized clinical trial, successfully tested in retrospective studies, has not been previously used in clinical interventional trials. We expect to demonstrate, by development of an statistical model, that a risk-based allocation method is a viable strategy as the basis for constructing a multicenter (possibly multinational) clinical trial.