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

Purpose: To assess the relationships of smoking and other cardiovascular di sease risk factors (hypertension, diabetes, hypercholesterolemia, and gende r) to rates of radiosurgery-induced obliteration of arteriovenous malformat ions (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 p atients. All patients had regular clinical or imaging follow-up for a minim um of 3 years after radiosurgery. Results: Multivariate analysis showed that smoking had no effect on AVM obl iteration (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 obliter ation rate than males (78% vs. 89%,p = 0.0102). Conclusion: Smoking has no effect on AVM obliteration. Hypertension, diabet es, and hypercholesterolemia had no discernible effect in this study. Furth er study is needed to establish whether estrogen has a vascular protective effect that could partially limit radiosurgical AVM obliteration, as sugges ted by this study. (C) 2001 Elsevier Science Inc.