J Neurosurg 143:499–504, 2025
Patients with ruptured cerebral AVMs were more likely to have deep location, deep venous drainage, lower flow, smaller nidal volume, smaller arterial feeders, and fewer draining veins than unruptured AVMs. These findings highlight the complex interplay between angioarchitecture, hemodynamics, and rupture risk.
• Lower AVM flow, smaller nidus volume, deep location, deep venous drainage, smaller arterial feeders, and fewer draining veins are associated with ruptured AVMs compared to unruptured ones.
• Male sex and deep AVM location significantly increase the risk of hemorrhagic presentation.
• AVM size and flow are not independent predictors when other variables are considered.
• Fewer draining veins, but not venous stenosis, are linked to rupture, suggesting venous outflow restriction may play a role.
• Findings support previous smaller QMRA-based studies showing lower flow is associated with rupture, despite some conflicting literature.
• Prerupture flow data are lacking; rupture itself may alter measured hemodynamics.
• Further research is needed to clarify the role of hemodynamics and venous occlusion in AVM rupture risk.
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