Leading Cause of Stroke in Young Going Untreated – and It Shouldn’t, Study Finds - AVMs

This seems to contradict the research that came out two weeks ago: What is your doctors take on this?

AVMs - Don't Mess With Brain Tangles, Study Warns —Longer follow-up from ARUBA trial confirmed benefit of no intervention Feb. 18, 2016

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Leading Cause of Stroke in Young Going Untreated – and It Shouldn’t, Study Finds

Ateriovenous malformations, the most common cause of strokes in children and young adults, are sometimes left untreated, but a sweeping new study strongly suggests that is generally a mistake.

The challenge that doctors have faced in treating patients with arteriovenous malformations – tangles of blood vessels prone to leaking and causing strokes – is that the treatment options are not without risk. So one approach commonly advocated has been to leave the condition unaddressed.
But the new study, led by the University of Virginia Health System and involving six other academic medical centers, has found the risks of treatment using Gamma Knife  radiosurgery are often significantly outweighed by the ever-increasing risk posed by leaving the condition untreated. This is particularly true among patients diagnosed – as is typically the case – while they are teenagers or young adults.
“These findings strongly suggest that patients who are younger are going to be far more likely to benefit from treatment than people who may be diagnosed later on in their life,” said neurosurgeon Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center. “If patients have at least a 10-year life expectancy, this new study strongly suggests treatment.”

in_line_image3-2.jpg

Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center, said that younger patients have the most to gain from aggressive treatment.

The new study takes a long-term view of the risks patients face, following them, on average, for more than seven years. The researchers looked at 509 patients who had been diagnosed as having arteriovenous malformations, but who had not suffered a stroke. The goal was to weigh the risk of leaving the condition untreated versus the risk posed by the least-invasive treatment option, Gamma Knife radiosurgery. “There’s a real uncertainty about the risk of stroke with these AVMs, but the general risk of stroke is thought to be about 1 [percent] to 3 percent per year,” Sheehan said. “When you factor that in over a 10-year period of time, you are talking about somewhere in the order of 10 to 30 percent risk of stroke, and that’s just the beginning if you’re diagnosed as a pediatric patient or a young adult.”
He noted the grim statistics physicians and patients – and, often, young patients’ parents – must consider in deciding to leave a malformation untreated: “If it ruptures, and the odds of it rupturing within the lifetime of a teenager are very high, the risk of death … is thought to be about 10 percent. So with each rupture, it’s about a 10 percent risk of dying, and that’s not even including the problems that can arise if it ruptures but doesn’t cause death: seizures, weakness, blindness and other neurological deficits.”
Gamma Knife radiosurgery, on the other hand, can close off arteriovenous malformations using fine beams of concentrated gamma rays, so that surgeons do not need to cut into the head. Approximately 80 percent of malformations can be closed off with this technique. However, it typically takes two to three years for the malformation to close fully after the procedure, and the risk of stroke remains during that time.
- See more at: https://news.virginia.edu/content/leading-cause-stroke-young-going-untreated-and-it-shouldnt-study-finds#sthash.fqT2xejE.dpuf

Ateriovenous malformations, the most common cause of strokes in children and young adults, are sometimes left untreated, but a sweeping new study strongly suggests that is generally a mistake.

The challenge that doctors have faced in treating patients with arteriovenous malformations – tangles of blood vessels prone to leaking and causing strokes – is that the treatment options are not without risk. So one approach commonly advocated has been to leave the condition unaddressed.

But the new study, led by the University of Virginia Health System and involving six other academic medical centers, has found the risks of treatment using Gamma Knife  radiosurgery are often significantly outweighed by the ever-increasing risk posed by leaving the condition untreated. This is particularly true among patients diagnosed – as is typically the case – while they are teenagers or young adults.

“These findings strongly suggest that patients who are younger are going to be far more likely to benefit from treatment than people who may be diagnosed later on in their life,” said neurosurgeon Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center. “If patients have at least a 10-year life expectancy, this new study strongly suggests treatment.”

Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center, said that younger patients have the most to gain from aggressive treatment.

The new study takes a long-term view of the risks patients face, following them, on average, for more than seven years. The researchers looked at 509 patients who had been diagnosed as having arteriovenous malformations, but who had not suffered a stroke. The goal was to weigh the risk of leaving the condition untreated versus the risk posed by the least-invasive treatment option, Gamma Knife radiosurgery.

“There’s a real uncertainty about the risk of stroke with these AVMs, but the general risk of stroke is thought to be about 1 [percent] to 3 percent per year,” Sheehan said. “When you factor that in over a 10-year period of time, you are talking about somewhere in the order of 10 to 30 percent risk of stroke, and that’s just the beginning if you’re diagnosed as a pediatric patient or a young adult.”

He noted the grim statistics physicians and patients – and, often, young patients’ parents – must consider in deciding to leave a malformation untreated: “If it ruptures, and the odds of it rupturing within the lifetime of a teenager are very high, the risk of death … is thought to be about 10 percent. So with each rupture, it’s about a 10 percent risk of dying, and that’s not even including the problems that can arise if it ruptures but doesn’t cause death: seizures, weakness, blindness and other neurological deficits.”

Gamma Knife radiosurgery, on the other hand, can close off arteriovenous malformations using fine beams of concentrated gamma rays, so that surgeons do not need to cut into the head. Approximately 80 percent of malformations can be closed off with this technique. However, it typically takes two to three years for the malformation to close fully after the procedure, and the risk of stroke remains during that time.

 

Ateriovenous malformations, the most common cause of strokes in children and young adults, are sometimes left untreated, but a sweeping new study strongly suggests that is generally a mistake.

The challenge that doctors have faced in treating patients with arteriovenous malformations – tangles of blood vessels prone to leaking and causing strokes – is that the treatment options are not without risk. So one approach commonly advocated has been to leave the condition unaddressed.
But the new study, led by the University of Virginia Health System and involving six other academic medical centers, has found the risks of treatment using Gamma Knife  radiosurgery are often significantly outweighed by the ever-increasing risk posed by leaving the condition untreated. This is particularly true among patients diagnosed – as is typically the case – while they are teenagers or young adults.
“These findings strongly suggest that patients who are younger are going to be far more likely to benefit from treatment than people who may be diagnosed later on in their life,” said neurosurgeon Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center. “If patients have at least a 10-year life expectancy, this new study strongly suggests treatment.”

in_line_image3-2.jpg

Dr. Jason Sheehan, director of the UVA Health System’s Gamma Knife Center, said that younger patients have the most to gain from aggressive treatment.

The new study takes a long-term view of the risks patients face, following them, on average, for more than seven years. The researchers looked at 509 patients who had been diagnosed as having arteriovenous malformations, but who had not suffered a stroke. The goal was to weigh the risk of leaving the condition untreated versus the risk posed by the least-invasive treatment option, Gamma Knife radiosurgery. “There’s a real uncertainty about the risk of stroke with these AVMs, but the general risk of stroke is thought to be about 1 [percent] to 3 percent per year,” Sheehan said. “When you factor that in over a 10-year period of time, you are talking about somewhere in the order of 10 to 30 percent risk of stroke, and that’s just the beginning if you’re diagnosed as a pediatric patient or a young adult.”
He noted the grim statistics physicians and patients – and, often, young patients’ parents – must consider in deciding to leave a malformation untreated: “If it ruptures, and the odds of it rupturing within the lifetime of a teenager are very high, the risk of death … is thought to be about 10 percent. So with each rupture, it’s about a 10 percent risk of dying, and that’s not even including the problems that can arise if it ruptures but doesn’t cause death: seizures, weakness, blindness and other neurological deficits.”
Gamma Knife radiosurgery, on the other hand, can close off arteriovenous malformations using fine beams of concentrated gamma rays, so that surgeons do not need to cut into the head. Approximately 80 percent of malformations can be closed off with this technique. However, it typically takes two to three years for the malformation to close fully after the procedure, and the risk of stroke remains during that time.
- See more at: https://news.virginia.edu/content/leading-cause-stroke-young-going-untreated-and-it-shouldnt-study-finds#sthash.fqT2xejE.dpuf