An analysis of the effects of smoking and other cardiovascular risk factors on obliteration rates after arteriovenous malformation radiosurgery

Abstract

Purpose: To assess the relationships of smoking and other cardiovascular disease risk factors (hypertension, diabetes, hypercholesterolemia, and gender) to rates of radiosurgery-induced obliteration of arteriovenous malformations (AVM).Methods and Materials: We evaluated follow-up imaging and clinical data in 329 AVM patients who received gamma knife radiosurgery at the University of Pittsburgh between 1987 and 1994. There were 113 smokers, 29 hypertensives, 5 diabetics, 4 hypercholesterolemics, 159 male patients, and 170 female patients. All patients had regular clinical or imaging follow-up for a minimum of 3 years after radiosurgery.Results: Multivariate analysis showed that smoking had no effect on AVM obliteration (p > 0.43). Hypertension, diabetes, and hypercholesterolemia had no discernible effect on AVM obliteration in this study (p > 0.78). However, females aged 12–49 had a statistically significant lower in-field obliteration rate than males (78% vs. 89%, p = 0.0102).Conclusion: Smoking has no effect on AVM obliteration. Hypertension, diabetes, and hypercholesterolemia had no discernible effect in this study. Further study is needed to establish whether estrogen has a vascular protective effect that could partially limit radiosurgical AVM obliteration, as suggested by this study.