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Regarding “Neurovascular Manifestations of Hereditary Hemorrhagic Telangiectasia: A Consecutive Series of 376 Patients during 15 Years”

Regarding “Neurovascular Manifestations of Hereditary Hemorrhagic Telangiectasia: A Consecutive... LETTERS Regarding“NeurovascularManifestationsofHereditary HemorrhagicTelangiectasia:AConsecutiveSeriesof376 Patientsduring15Years” e would like to thank the authors Brinjikji et al for their patients. The authors acknowledged absence of cerebral angiog- Wstudy titled “Neurovascular Manifestations of Hereditary raphy in all patients as a limitation of the study because angiogra- Hemorrhagic Telangiectasia: A Consecutive Series of 376 Patients phy is more sensitive for detection of smaller AVMs. Do the au- during 15 Years.” The authors have nicely described the spectrum thors advocate angiography in all patients? Other than finding of cerebrovascular lesions in a large series of patients with hered- additional small AVMs, could the authors elaborate on the added itary hemorrhagic telangiectasia (HHT). utility of performing angiography? Did any patients receive repeat The authors included only patients with definite HHT (met imaging? 3 of 4 Curacao criteria) and had a group of 376 patients over a Of the spectrum of vascular lesions described in patients with 15-year period. Could the authors tell us how many patients in HHT, the nidus-type AVMs may not have a completely benign total were imaged for screening for HHT during this time period natural history. The rationale for screening patients with HHT for at their institution? Did these patients have any neurologic symp- brain vascular malformations has been stated to be to detect a toms, or was neuroimaging performed to screen for brain vascu- vascular malformation before the development of a debilitating lar malformations? The authors stated that screening MR imaging hemorrhage. However, there is absence of literature proving that may be warranted for both adults and children. However, the screening or preemptive treatment are effective strategies in HHT. group formulating the guidelines found only Level 3 evidence for It would be very helpful if the authors, through their large series, this recommendation (opinions of respected authorities, based can answer these questions. on clinical experience, descriptive studies, or reports of expert committees). To better understand the utility of screening, an- Disclosures: Kimberly Seifert—UNRELATED: Employment: Virginia Commonwealth swers to a few questions would be helpful. University, Yale, Comments: residency training compensation. Five patients in this study with single nidal brain AVMs pre- sented with hemorrhage. Could the authors describe how many other patients included in the study had hemorrhage over the REFERENCES course of the study (assuming follow-up was available) and how 1. Brinjikji W, Iyer VN, Yamaki V, et al. Neurovascular manifestations of hereditary hemorrhagic telangiectasia: a consecutive series of 376 many patients were treated? It would also help if the authors could patients during 15 years. AJNR Am J Neuroradiol 2016;37:1479–86 mention the criteria used for treatment of nidal AVMs in these CrossRef Medline patients. Did any of the treated patients develop complications 2. Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guide- from treatment or have hemorrhage on follow-up? lines for the diagnosis and management of hereditary haemorrhagic We would also appreciate if the authors could comment on the telangiectasia. J Med Genet 2011;48:73–87 CrossRef Medline X A. Malhotra utility of vascular imaging in this patient subset. CTA/MRA was X X. Wu performed in 140 patients (37.2%), and DSA performed in 46 X K. Seifert Department of Radiology and Biomedical Imaging Yale School of Medicine http://dx.doi.org/10.3174/ajnr.A4986 New Haven, Connecticut E16 Letters Feb 2017 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Regarding “Neurovascular Manifestations of Hereditary Hemorrhagic Telangiectasia: A Consecutive Series of 376 Patients during 15 Years”

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Publisher
American Journal of Neuroradiology
Copyright
© 2017 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A4986
pmid
27765743
Publisher site
See Article on Publisher Site

Abstract

LETTERS Regarding“NeurovascularManifestationsofHereditary HemorrhagicTelangiectasia:AConsecutiveSeriesof376 Patientsduring15Years” e would like to thank the authors Brinjikji et al for their patients. The authors acknowledged absence of cerebral angiog- Wstudy titled “Neurovascular Manifestations of Hereditary raphy in all patients as a limitation of the study because angiogra- Hemorrhagic Telangiectasia: A Consecutive Series of 376 Patients phy is more sensitive for detection of smaller AVMs. Do the au- during 15 Years.” The authors have nicely described the spectrum thors advocate angiography in all patients? Other than finding of cerebrovascular lesions in a large series of patients with hered- additional small AVMs, could the authors elaborate on the added itary hemorrhagic telangiectasia (HHT). utility of performing angiography? Did any patients receive repeat The authors included only patients with definite HHT (met imaging? 3 of 4 Curacao criteria) and had a group of 376 patients over a Of the spectrum of vascular lesions described in patients with 15-year period. Could the authors tell us how many patients in HHT, the nidus-type AVMs may not have a completely benign total were imaged for screening for HHT during this time period natural history. The rationale for screening patients with HHT for at their institution? Did these patients have any neurologic symp- brain vascular malformations has been stated to be to detect a toms, or was neuroimaging performed to screen for brain vascu- vascular malformation before the development of a debilitating lar malformations? The authors stated that screening MR imaging hemorrhage. However, there is absence of literature proving that may be warranted for both adults and children. However, the screening or preemptive treatment are effective strategies in HHT. group formulating the guidelines found only Level 3 evidence for It would be very helpful if the authors, through their large series, this recommendation (opinions of respected authorities, based can answer these questions. on clinical experience, descriptive studies, or reports of expert committees). To better understand the utility of screening, an- Disclosures: Kimberly Seifert—UNRELATED: Employment: Virginia Commonwealth swers to a few questions would be helpful. University, Yale, Comments: residency training compensation. Five patients in this study with single nidal brain AVMs pre- sented with hemorrhage. Could the authors describe how many other patients included in the study had hemorrhage over the REFERENCES course of the study (assuming follow-up was available) and how 1. Brinjikji W, Iyer VN, Yamaki V, et al. Neurovascular manifestations of hereditary hemorrhagic telangiectasia: a consecutive series of 376 many patients were treated? It would also help if the authors could patients during 15 years. AJNR Am J Neuroradiol 2016;37:1479–86 mention the criteria used for treatment of nidal AVMs in these CrossRef Medline patients. Did any of the treated patients develop complications 2. Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guide- from treatment or have hemorrhage on follow-up? lines for the diagnosis and management of hereditary haemorrhagic We would also appreciate if the authors could comment on the telangiectasia. J Med Genet 2011;48:73–87 CrossRef Medline X A. Malhotra utility of vascular imaging in this patient subset. CTA/MRA was X X. Wu performed in 140 patients (37.2%), and DSA performed in 46 X K. Seifert Department of Radiology and Biomedical Imaging Yale School of Medicine http://dx.doi.org/10.3174/ajnr.A4986 New Haven, Connecticut E16 Letters Feb 2017 www.ajnr.org

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Feb 1, 2017

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