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Multicenter Study
. 2025 Jun 15:473:123503.
doi: 10.1016/j.jns.2025.123503. Epub 2025 Apr 12.

Outcomes of arteriovenous malformations with single versus multiple draining veins: A multicenter study

Basel Musmar  1 , Hammam Abdalrazeq  2 , Nimer Adeeb  3 , Joanna M Roy  1 , Assala Aslan  2 , Stavropoula I Tjoumakaris  1 , Hamza Adel Salim  2 , Christopher S Ogilvy  4 , Mustafa K Baskaya  5 , Douglas Kondziolka  6 , Jason Sheehan  7 , Howard Riina  6 , Sandeep Kandregula  8 , Adam A Dmytriw  9 , Abdallah Abushehab  10 , Kareem El Naamani  1 , Ahmed Abdelsalam  11 , Natasha Ironside  7 , Deepak Kumbhare  12 , Sanjeev Gummadi  12 , Cagdas Ataoglu  5 , Muhammed Amir Essibayi  13 , Abdullah Keles  5 , Sandeep Muram  4 , Daniel Sconzo  4 , Arwin Rezai  14 , Omar Alwakaa  4 , Salem M Tos  7 , Georgios Mantziaris  7 , Min S Park  7 , Ufuk Erginoglu  5 , Johannes Pöppe  14 , Rajeev D Sen  15 , Christoph J Griessenauer  14 , Jan-Karl Burkhardt  8 , Robert M Starke  11 , Laligam N Sekhar  15 , Michael R Levitt  15 , David J Altschul  13 , Neil Haranhalli  13 , Malia McAvoy  15 , Hussein A Zeineddine  16 , Adib A Abla  11 , Saman Sizdahkhani  1 , Sravanthi Koduri  1 , Elias Atallah  1 , Spyridon Karadimas  1 , M Reid Gooch  1 , Robert H Rosenwasser  1 , Christopher Stapleton  8 , Matthew Koch  17 , Visish M Srinivasan  8 , Peng R Chen  16 , Spiros Blackburn  16 , Ketan Bulsara  18 , Louis J Kim  15 , Omar Choudhri  8 , Bryan Pukenas  8 , Darren Orbach  19 , Edward Smith  20 , Pascal J Mosimann  21 , Ali Alaraj  22 , Mohammad A Aziz-Sultan  23 , Aman B Patel  9 , Amey Savardekar  12 , Christina Notarianni  12 , Hugo H Cuellar  24 , Michael Lawton  25 , Bharat Guthikonda  12 , Jacques Morcos  16 , Pascal Jabbour  26 ; MISTA consortium
Affiliations
Multicenter Study

Outcomes of arteriovenous malformations with single versus multiple draining veins: A multicenter study

Basel Musmar et al. J Neurol Sci. .

Abstract

Background: Cerebral arteriovenous malformations (AVMs) are complex vascular lesions that pose a risk for hemorrhagic stroke. The number of draining veins has recently emerged as a significant predictor of rupture risk. This multicenter study aimed to evaluate the outcomes in adult AVM patients with single versus multiple draining veins.

Methods: We conducted a retrospective analysis of 735 AVM patients from the Multicenter International Study for Treatment of Brain AVMs (MISTA) database. Patients were categorized into single draining vein (n = 430) and multiple draining veins (n = 305) groups. Logistic and linear regression models were used to assess outcomes, adjusting for baseline characteristics, including age, rupture status, Spetzler-Martin grade, and other relevant factors.

Results: After adjustment, no significant differences were observed in complete AVM obliteration at last follow-up between the multiple and single draining veins groups (OR: 1.1; 95 % CI: 0.72-1.93, p = 0.49) after any treatment type. Good functional outcomes at last follow-up (mRS 0-2) were similar between the two groups (OR: 1.00; 95 % CI: 0.48-2.09, p = 0.98), as were retreatment rates (OR: 1.68; 95 % CI: 0.74-3.83, p = 0.21). Ruptured AVMs were more common in the single draining vein group (52.0 % vs. 35.4 %, p < 0.001). Patients in the multiple draining vein group had lower odds of hemorrhagic complications compared to the single vein group (OR: 0.38; 95 % CI: 0.14-1.02, p = 0.05).

Conclusion: Single draining vein AVMs were more likely to present with rupture, but no significant differences in obliteration rates, functional outcomes, or retreatment rates were found between the groups after adjustment. These findings suggest that while venous drainage patterns may influence initial presentation, they do not appear to affect overall treatment success or patient prognosis after any treatment type. Further studies are needed to confirm.

Keywords: AVM; Multicenter; Multiple draining vein; Outcomes; Single draining vein.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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