Citations 2
Outcomes of arteriovenous malformation patients with multiple versus single feeders: A multicenter retrospective study with propensity-score matching
Musmar, Basel , Adeeb, Nimer , Abdalrazeq, Hammam , Tjoumakaris, Stavropoula I, Salim, Hamza , Kondziolka, Douglas, Sheehan, Jason P. , Ogilvy, Christopher S. , Riina, Howard A. , Naamani, Kareem El, Ironside, Natasha , Ataoglu, Cagdas , Keleş, Abdullah , Muram, Sandeep , Sconzo, Daniel , Rezai, Arwin, Alwakaa, Omar , Erginoğlu, Ufuk , Sen, Rajeev , Griessenauer, Christoph J., Burkhardt, Jan-Karl, Starke, Robert M., Başkaya, Mustafa K. , Levitt, Michael R, Altschul, David , McAvoy, Malia , Aslan, Assala , Abushehab, Abdallah, Swaid, Christian, Abla, Adib A. , Sizdahkhani, Saman , Koduri, Sravanthi , Atallah, Elias , Karadimas, Spyridon, Gooch, M Reid, Rosenwasser, Robert H. , Stapleton, Christopher J. , Koch, Matthew J. , Srinivasan, Visish M. , Cochran, Joseph, Pukenas, Bryan , Smith, Edward, Patel, Aman B. , Cuellar, Hugo H, Lawton, Michael T. , Guthikonda, Bharat , Ogilvy, Christopher S. , Alaraj, Ali , Smith, Edward R. , Salim, Hamza , Essibayi, Muhammed Amir , Alwakaa, Omar , Mosimann, Pascal J , Jabbour, Pascal , Alaraj, Ali , Abla, Adib , Altschul, David J , Musmar, Basel , Ogilvy, Christopher S , Keles, Abdullah , Erginoglu, Ufuk , Smith, Edward , Burkhardt, Jan‐Karl , Roy, Joanna M. , Tjoumakaris, Stavropoula , Kandregula, Sandeep , Dmytriw, Adam A. , Naamani, Kareem El , Abdelsalam, Ahmed , Kumbhare, Deepak , Essibayi, Muhammed Amir , Rezai, Arwin, Tos, Salem M , Pöppe, Johannes , Sen, Rajeev D, Griessenauer, Christoph J. , Sekhar, Laligam N. , Karadimas, Spyridon K. , Gooch, Michael Reid , Chen, Peng R , Blackburn, Spiros , Choudhri, Omar , Orbach, Darren B. , Aziz‐Sultan, Mohammad Ali , Morcos, Jacques J. , Jabbour, Pascal
European Stroke Journal | February 15, 2025 | Volume: 10 | Issue: 3 | Pages: 946-960
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.
Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I–III: a propensity score matched study
Musmar, Basel , Adeeb, Nimer , Roy, Joanna M. , Abdalrazeq, Hammam , Tjoumakaris, Stavropoula , Atallah, Elias , Salim, Hamza , Sheehan, Jason , Ogilvy, Christopher S. , Riina, Howard A. , Naamani, Kareem El, Ironside, Natasha , Ataoglu, Cagdas , Essibayi, Muhammed Amir , Keleş, Abdullah , Muram, Sandeep , Sconzo, Daniel , Rezai, Arwin, Erginoğlu, Ufuk , Sen, Rajeev , Burkhardt, Jan‐Karl , Starke, Robert M., Başkaya, Mustafa K. , Altschul, David , McAvoy, Malia , Aslan, Assala , Abushehab, Abdallah, Swaid, Christian, Abla, Adib A. , Rosenwasser, Robert H. , Stapleton, Christopher J. , Koch, Matthew J. , Srinivasan, Visish M. , Dannenbaum, Mark J. , Pukenas, Bryan , Smith, Edward, Alaraj, Ali , Patel, Aman B. , Cuellar, Hugo H, Lawton, Michael T. , Guthikonda, Bharat , Jabbour, Pascal , Smith, Edward R. , Tjoumakaris, Stavropoula , Salim, Hamza , Ogilvy, Christopher S , Kandregula, Sandeep , Dmytriw, Adam A , Essibayi, Muhammed Amir , Griessenauer, Christoph J , Levitt, Michael R , Altschul, David J , Aslan, Assala , Stapleton, Christopher , Koch, Matthew J , Chen, Peng R , Dannenbaum, Mark J , Choudhri, Omar , Alaraj, Ali , Guthikonda, Bharat , Jabbour, Pascal , Abla, Adib , Musmar, Basel , Keles, Abdullah , Erginoglu, Ufuk , Smith, Edward , Kondziolka, Douglas , Kandregula, Sandeep , Dmytriw, Adam A. , Naamani, Kareem El , Abdelsalam, Ahmed , Kumbhare, Deepak , Rezai, Arwin, Pöppe, Johannes , Sen, Rajeev D, Griessenauer, Christoph J. , Sekhar, Laligam N. , Levitt, Michael R. , Gooch, Michael Reid , Blackburn, Spiros , Choudhri, Omar , Orbach, Darren B. , Mosimann, Pascal J , Aziz‐Sultan, Mohammad Ali , Morcos, Jacques J. , Jabbour, Pascal
Journal of NeuroInterventional Surgery | October 4, 2024 | Volume: 17 | Issue: 12 | Pages: 1382-1390
Background Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives. Objective To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I–III. Methods This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I–III between January 2010 and December 2023 were included. Results The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03). Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group. Conclusion Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed.