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Paper title Bleeding risk of cerebral cavernous malformations in patients on beta blocker medication: A cohort study
Paper code P16
  1. Johannes Goldberg Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Speaker
  2. Christian Jaeggi University of Bern, Switzerland
  3. Daniel Schoeni Inselspital, Bern University Hospital, University of Bern, Switzerland
  4. Pasquale Mordasini Kantonsspital St. Gallen
  5. Andreas Raabe Inselspital - Universitätsspital Bern
  6. David Bervini Inselspital, Bern University Hospital, University of Bern, Switzerland
Form of presentation Poster
  • SSNS-Neurosurgery
Abstract text Aim
Cerebral cavernous malformations (CCMs) are frequently diagnosed vascular malformations of the brain. Although most CCMs are asymptomatic, some can be responsible for intracerebral hemorrhage or seizures. In selected cases, microsurgical resection belongs to the preferred treatment options. Treatment with the unselective β-blocker Propranolol has been presumed to stabilize and eventually lead to CCMs size regression in a limited number of published case series (1-5). However, the underlying mechanism and the evidence for this effect remains unclear. The aim of this study was to investigate the risk for CCM-related hemorrhage in patients on long-term β-blocker medication.

A retrospective single center database containing data of 408 patients harboring 542 CCMs was interrogated for a time period of 35 years. Descriptive and survival analysis were performed, focusing on the risk of hemorrhage at presentation and during follow-up in patients on long-term β-blocker medication versus not. Follow-up was censored at the first occurrence of either new hemorrhage, surgery or last clinical review. β-blocker medication was divided in the following main subgroups: any β-blocker, β1-selective β-blocker and any unselective β-blocker.

Of 542 included CCMs, 81 (14.9%) were under a treatment with any β-blocker, 65 (12%) received β1-selective and 16 (3%) any unselective β-blockers. 136 (25.1%) CCMs presented with hemorrhage at diagnosis. None of the β-blocker subgroups was associated with a lower risk of hemorrhage at the time of diagnosis [any β-blocker (p=0.64), β1-selective (p=0.93), any unselective β-blocker (p=0.25)]. 496 CCMs were included into the survival analysis, for a total of 1800 lesion-years. Follow-up hemorrhage occurred in 36 (7.3%) CCMs. β-blocker medication was not associated with a decreased risk for follow-up hemorrhage [any β-blocker (p=0.70; HR 1.19, 95% CI 0.49-2.90), β1-selective (p=0.78; HR 1.15, 95% CI 0.44-3.00), any unselective β-blocker (p=0.76; HR 1.37, 95% CI 0.19-10.08)]. Multivariate cox proportional hazard regression including brainstem location, hemorrhage at diagnosis, age and any β-blocker treatment showed no reduced risk for follow-up hemorrhage under any β-blocker treatment (p=0.53; HR 1.36, 95% CI 0.52-3.56).

In this retrospective cohort study, β-blocker medication does not seem to be associated with a decreased risk of CCM-related hemorrhage at presentation or during follow-up.