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Multicenter Study
. 2025 Sep;10(3):946-960.
doi: 10.1177/23969873251319924. Epub 2025 Feb 15.

Outcomes of arteriovenous malformation patients with multiple versus single feeders: A multicenter retrospective study with propensity-score matching

Basel Musmar  1 , Nimer Adeeb  2   3 , Hammam Abdalrazeq  1 , Joanna M Roy  1 , Stavropoula I Tjoumakaris  1 , Hamza Adel Salim  4 , Douglas Kondziolka  5 , Jason Sheehan  6 , Christopher S Ogilvy  7 , Howard Riina  5 , Sandeep Kandregula  8 , Adam A Dmytriw  9 , Kareem El Naamani  1 , Ahmed Abdelsalam  10 , Natasha Ironside  6 , Deepak Kumbhare  3 , Cagdas Ataoglu  11 , Muhammed Amir Essibayi  12 , Abdullah Keles  11 , Sandeep Muram  7 , Daniel Sconzo  7 , Arwin Rezai  13 , Omar Alwakaa  7 , Salem M Tos  6 , Ufuk Erginoglu  11 , Johannes Pöppe  13 , Rajeev D Sen  14 , Christoph J Griessenauer  13 , Jan-Karl Burkhardt  8 , Robert M Starke  10 , Mustafa K Baskaya  11 , Laligam N Sekhar  14 , Michael R Levitt  14 , David J Altschul  12 , Malia McAvoy  14 , Assala Aslan  4 , Abdallah Abushehab  15 , Christian Swaid  2 , Adib A Abla  10 , Saman Sizdahkhani  1 , Sravanthi Koduri  1 , Elias Atallah  1 , Spyridon Karadimas  1 , M Reid Gooch  1 , Robert H Rosenwasser  1 , Christopher Stapleton  9 , Matthew Koch  16 , Visish M Srinivasan  8 , Peng R Chen  3 , Spiros Blackburn  3 , Joseph Cochran  3 , Omar Choudhri  8 , Bryan Pukenas  8 , Darren Orbach  17 , Edward Smith  18 , Pascal J Mosimann  19 , Ali Alaraj  20 , Mohammad A Aziz-Sultan  21 , Aman B Patel  9 , Hugo H Cuellar  2   4 , Michael Lawton  22 , Bharat Guthikonda  2 , Jacques Morcos  3 , Pascal Jabbour  1
Affiliations
Multicenter Study

Outcomes of arteriovenous malformation patients with multiple versus single feeders: A multicenter retrospective study with propensity-score matching

Basel Musmar et al. Eur Stroke J. 2025 Sep.

Abstract

Introduction: The impact of multiple feeding arteries on clinical outcomes of cerebral arteriovenous malformations (AVMs) is not well understood. This study aims to compare outcomes between AVMs with multiple versus single feeding arteries.

Patients and methods: Data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium were analyzed. Propensity score matching (PSM) was used to balance cohorts. Subgroup analysis was conducted for ruptured and unruptured AVMs and different treatment options, and multivariable logistic regression was applied to assess the impact of feeding artery origin.

Results: Among 953 patients, 661(69.4%) had multiple feeding arteries, and 292 (30.6%) had a single feeding artery. After PSM, which included 422 matched patients (211 in each group), the differences in obliteration rates (68.7% vs 74.8%, OR 0.73, 95% CI: 0.48-1.12, p = 0.16) and symptomatic complications (15.6% vs 11.8%, OR 1.37, 95% CI: 0.78-2.41, p = 0.25) were not significant. Subgroup analysis comparing ruptured and unruptured AVMs and different treatment options showed no significant differences across all subgroups. Multivariable analysis identified PICA feeders as significantly associated with increased odds of all complications (OR 7.33, 95% CI: 2.14-25.1, p = 0.002).

Discussion and conclusion: AVMs with a single feeding artery were more likely to present with rupture, but no significant differences in obliteration rates or complications were observed between the groups after PSM. These findings suggest that while the number of feeding arteries may influence the initial presentation, it does not appear to impact overall treatment success or patient prognosis. Further prospective studies are needed to confirm these findings.

Keywords: AVM; Arteriovenous malformation; PSM; feeders; multicenter.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical Abstract
Graphical Abstract
This is a visual representation of the abstract.
Figure 1.
Figure 1.
Comparison of complete obliteration rate at last follow-up between multiple and single feeders groups before and after PSM.
Figure 2.
Figure 2.
Comparison of symptomatic complication rate between multiple and single feeders groups before and after PSM.
Figure 3.
Figure 3.
Kaplan-Meier curve comparing different feeders origin.
Figure 4.
Figure 4.
Sub-group analysis of ruptured and not ruptured AVMs.
Figure 5.
Figure 5.
Sub-group analysis of different treatment types.
See this image and copyright information in PMC

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