Predictors of complete obliteration and favourable outcome after single-modality treatment for low-grade arteriovenous malformations: a multicentre study.

Authors

Angelica M Fuentes, Salem M Tos, Natasha Ironside, Georgios Mantziaris, Yuki Shinya, Basel Musmar, Hamza Adel Salim, Nimer Adeeb, Christopher S Ogilvy, Douglas Kondziolka, Ali Alaraj, Min S Park, Adam A Dmytriw, Hussein Zeineddine, Finn Mccarthy, Hussam Abou-Al-Shaar, Ahmed Abdelsalam, Mustafa Baskaya, Cagdas Ataoglu, Anthony Sanchez-Forteza, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Howard Riina, Arwin Rezai, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Davide Simonato, Yan-Lin Li, Sandeep Kandregula, Dhairya A Lakhani, Christoph J Griessenauer, Rahim Abo Kasem, Alejandro M Spiotta, Ajit S Puri, Jasmeet Singh, Anna Luisa Kuhn, Jan Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael R Levitt, David Altschul, Neil Haranhalli, Malia McAvoy, Paul Foreman, Osama O Zaidat, Mohammad H AlMajali, Hakeem J Shakir, Alfred Pokmeng See, Adib A Abla, Aashay Patel, Andrew Nguyen, Matthew J Koch, Visish M Srinivasan, Peng Roc Chen, Spiros Blackburn, Ketan R Bulsara, Peter Kan, Louis Kim, Omar Choudhri, Stavropoula I Tjoumakaris, Pascal Jabbour, Amey Savardekar, Hugo H Cuellar, Michael T Lawton, Bharat Guthikonda, Jacques Morcos, Jason P Sheehan, MISTA Consortium

Published in

European stroke journal. Volume 11. Issue 8. Aug 05, 2026.

Abstract

Patient and arteriovenous malformation (AVM) characteristics that portend success after treatment for low-grade brain AVMs remain unknown.
We utilised the MISTA multicentre registry to identify patients with Spetzler-Martin (SM) grade I or II AVMs treated with stand-alone curative-intent intervention (resection, stereotactic radiosurgery [SRS] or endovascular embolisation). Bivariate and multivariable analyses were performed to identify patient and AVM characteristics predictive of complete obliteration or favourable outcome (complete obliteration without new permanent deficit or post-treatment haemorrhage).
A total of 522 patients were included (292 microsurgery, 152 SRS, 78 embolisation). Complete obliteration rates differed between microsurgery (95.9%), SRS (75.0%) and embolisation (71.8%) (P < .001); among patients classified as cured, digital subtraction angiography (DSA) confirmed obliteration in 96.1%, 75.9% and 52.4%, respectively. Favourable outcome was achieved in 89.4%, 64.5% and 67.9% (P < .001). In adjusted models for obliteration, elderly age (odds ratio [OR] 0.49, P = .022), larger nidus (OR 0.64, P = .005) and compacted morphology (OR 1.93, P = .019) were independent predictors overall; paediatric age predicted incomplete obliteration after microsurgery (OR 0.05, P = .045), and elderly age (OR 0.19, P = .001) and larger nidus (OR 0.59, P = .015) after SRS. For favourable outcome, SM grade II overall (adjusted OR [aOR] 0.58, P = .031) and elderly age after SRS (aOR 0.31, P = .019) were independent negative predictors.
Low-grade AVMs showed high rates of complete obliteration, though DSA-confirmed rates were substantially lower after embolisation, underscoring the importance of angiographic confirmation.
The predictors identified in this study may help guide management when 2 or 3 of the primary treatment options carry clinical equipoise.

PMID:
42673144
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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