{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:36:05Z","timestamp":1791650165481,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>The aim was to investigate the effect of modifiable vascular risk factors on the risk of first and recurrent bleeding for patients with a cavernous malformation (CM) of the central nervous system (CNS) over a 10\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of our CM institutional database was performed spanning from 2003 to 2021. The inclusion criteria were non\u2010missing serial magnetic resonance imaging studies and clinical baseline metrics such as vascular risk factors. The exclusion criteria were patients who underwent surgical CM removal and patients with less than a decade of follow\u2010up. Kaplan\u2013Meier and Cox regression analyses were performed to determine the cumulative risk (10\u2009years) of hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010nine patients with a CM of the CNS were included. Our results showed a non\u2010significant increased risk of hemorrhage during 10\u2009years of follow\u2010up in patients using nicotine (hazard ratio 2.11, 95% confidence interval 0.86\u20135.21) and in patients with diabetes (hazard ratio 3.25, 95% confidence interval 0.71\u201314.81). For the presence of modifiable vascular risk factors at study baseline different cumulative 10\u2010year risks of bleeding were observed: arterial hypertension 42.9% (18.8%\u201370.4%); diabetes 66.7% (12.5%\u201398.2%); hyperlipidemia 30% (8.1%\u201364.6%); active nicotine abuse 50% (24.1%\u201376%); and obesity 22.2% (4%\u201359.8%). Overall cumulative (10\u2010year) hemorrhage risk was 30.3% (21.3%\u201341.1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The probability of hemorrhage in untreated CNS CM patients increases progressively within a decade of follow\u2010up. None of the modifiable vascular risk factors showed strong indication for an influence on hemorrhage risk, but our findings may suggest a more aggressive course in patients with active nicotine abuse or suffering from diabetes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15737","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T13:54:25Z","timestamp":1676123665000},"page":"1346-1351","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Modifiable vascular risk factors in patients with cerebral and spinal cavernous malformations: a complete 10\u2010year follow\u2010<scp>up<\/scp> study"],"prefix":"10.1111","volume":"30","author":[{"given":"Steffen","family":"Rauscher","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Spine Surgery University Hospital Essen  Essen Germany"},{"name":"Center for Translational Neuroscience and Behavioral Science (C\u2010TNBS) 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Biometry and Epidemiology University Hospital of Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-7289","authenticated-orcid":false,"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnau","family":"Benet","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Barrow Neurological Institute  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Jabbarli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spine Surgery University Hospital Essen  Essen Germany"},{"name":"Center for Translational Neuroscience and Behavioral Science (C\u2010TNBS) University of Duisburg\u2010Essen  Essen 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