Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Mar 21;48(1):313.
doi: 10.1007/s10143-025-03468-3.

Risk factors for bleeding in patients with arteriovenous malformations associated with intracranial aneurysms

Nebojsa Lasica #  1   2   3 , Hanah Hadice Gull #  4   5 , Ulrich Sure  4   5 , Petar Vulekovic  6   7 , Djula Djilvesi  6   7 , Dragan Andjelic  8 , Ramazan Jabbarli  4   5 , Cornelius Deuschl  9 , Marvin Darkwah Oppong  4   5
Affiliations
Multicenter Study

Risk factors for bleeding in patients with arteriovenous malformations associated with intracranial aneurysms

Nebojsa Lasica et al. Neurosurg Rev. .

Abstract

Background and objectives: Natural history of brain arteriovenous malformations (bAVMs) with associated intracranial aneurysms (IAs) reveals a higher rate of hemorrhage. We aimed to identify the prevalence and risk factors for hemorrhage in a subgroup of patients with bAVMs and associated arterial IAs.

Methods: The authors conducted an international, bicentric retrospective study of patients with ruptured and unruptured bAVMs with associated IAs treated at tertiary centers between January 2013 and December 2022. Sociodemographic data, clinical characteristics, and radiological parameters in patients with bAVM and associated IAs were analyzed.

Results: Of 944 patients with bAVM, 137 individuals with 191 associated arterial IAs were included in the final analysis. Bleeding presentation was documented in 85 cases (62.0%). The mean size of bAVM-associated IAs was 6.8 (SD = 4.8) mm. Multiple intracranial aneurysms (MIA) were present in 35 patients (25.5%). bAVM-associated IAs were classified as nidal in 19.0%, flow-related in 73.7%, and unrelated in 7.3% of cases. Univariate analysis revealed that arterial hypertension (odds ratio 4.37 [CI 1.52-12.57]; P =.004), history of smoking (odds ratio 5.77 [CI 1.26-26.53]; P =.013), and high-grade bAVMs (grades IV/V, odds ratio 0.35 [CI 0.15-0.87]; P =.02), were associated with a bleeding risk. In the multivariable analysis, only arterial hypertension remained significantly associated with the bleeding event (adjusted odds ratio 3.37 [CI 1.07-10.58]; P =.038).

Conclusions: Observational data from our large bicentric cohort of patients with bAVM and associated IAs identified arterial hypertension as a risk factor associated with an increased risk of bleeding.

Trial registration: The study was approved by the Institutional Review Board (IRB) of the University Clinical Center of Vojvodina and the University of Duisburg-Essen (20-9288-BO).

Keywords: Arteriovenous malformation; Associated aneurysm; Bleeding; Risk factors.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: The study was approved by the Institutional Review Board (IRB) of the University Clinical Center of Vojvodina and the University of Duisburg-Essen (20-9288-BO). Consent to participate: N/A (retrospective observational study). Consent to publish: N/A (no identifable patient data/imaging included). Competing interests: The authors declare no competing interests.

References

    1. D’Aliberti G, Talamonti G, Cenzato M, Camera AL, Debernardi A, Valvassori L, Mariangela P, Nichelatti M (2015) Arterial and venous aneurysms associated with arteriovenous malformations. World Neurosurg 83:188–196. https://doi.org/10.1016/j.wneu.2014.05.037 - DOI - PubMed
    1. Cagnazzo F, Brinjikji W, Lanzino G (2016) Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir 158:2095–2104. https://doi.org/10.1007/s00701-016-2957-3 - DOI - PubMed
    1. Stapf C, Mohr JP, Pile-Spellman J, Sciacca RR, Hartmann A, Schumacher HC, Mast H (2002) Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation. J Neurol Neurosurg Psychiatry 73:294–298. https://doi.org/10.1136/jnnp.73.3.294 - DOI - PubMed - PMC
    1. Brown RD Jr., Wiebers DO, Forbes GS (1990) Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. J Neurosurg 73:859–863. https://doi.org/10.3171/jns.1990.73.6.0859 - DOI - PubMed
    1. Platz J, Berkefeld J, Singer OC, Wolff R, Seifert V, Konczalla J, Güresir E (2014) Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir 156:2025–2034. https://doi.org/10.1007/s00701-014-2225-3 - DOI - PubMed

Publication types

LinkOut - more resources