Cohort study demonstrates reduced long-term hemorrhage risk following intervention for brain arteriovenous malformations, suggesting improved safety without worse functional outcomes.
Key Points
To compare long-term hemorrhagic and functional outcomes between active intervention and observation in patients with brain arteriovenous malformations.
Conducted a retrospective, single-center cohort study evaluating 220 eligible patients (108 ruptured, 112 unruptured) with angiographically confirmed brain arteriovenous malformations evaluated between 2000 and 2025.
Compared initial observation (N=82) against intervention via embolization, microsurgery, stereotactic radiosurgery, or multimodal therapy (N=138) over a median follow-up of 7.4 years (1943 patient-years).
Evaluated the primary outcome of any bAVM-related intracranial hemorrhage and secondary functional outcomes (mRS 0–2) using Kaplan-Meier, multivariable Cox regression, and inverse probability of treatment weighting.
Ten-year hemorrhage-free survival for the primary endpoint was 93% in the intervention group compared with 66% in the observation group (log-rank p<0.001).
Annual follow-up hemorrhage rates were 0.4% in the intervention cohort versus 3.2% in the observation cohort, with intervention remaining independently protective across ruptured and unruptured subgroups.
At last follow-up, favorable functional outcomes (mRS 0–2) were observed in 74% of patients receiving intervention compared with 68% of patients managed with observation.