ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicResearch on the Correlative Mechanisms and Clinical Exploration of Headache and Cerebrovascular DiseasesView all 5 articles
Risk Factors of Flow-related Aneurysm Rupture Associated with Posterior Circulation Arteriovenous Malformation: A Multicenter Retrospective Study
Provisionally accepted
Yifei Wang1
Guangxi Li1Chenyuan Li1Shu Chen1
Ropafadzo Leocardia Chekera1
Hanxiao Chang1Han Luo2
Wenyan Li3Zheng Li1
Chao Lin1
Xiupeng Xu1
Zhi Chen3*
Wen Li2*
Hua Lu1*- 1First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- 2First Affiliated Hospital of Soochow University, Suzhou, China
- 3The Southwest Hospital of AMU, Chongqing, China
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Background: Flow-related aneurysms (FA) is more common and of higher rupture risk in posterior circulation arteriovenous malformations (pAVM). However, risk factors for FA rupture in pAVMs are understudied and warrant further investigation. Objective: To investigate risk factors for FA rupture associated with pAVMs using multi-centric database from January 1 2020 to December 31 2024. Methods: Patients diagnosed with AVM were selected from databases. Patients with ruptured FAs and those with unruptured FAs were compared. Independent student's t-test, Mann-Whitney U test, Fisher's exact test and multivariable binary logistic regression were used to analyze. Results: Among 284 patients, 37 patients with 22 ruptured FAs and 28 unruptured FAs met the inclusion criteria. Ruptured FAs Ruptured FA are associated with located in smaller pAVMs (2.41 ± 1.02 cm vs 3.93 ± 2.68 cm, P = 0.001) and Spetzler–Martin grading I to II (P = 0.013). Patients with ruptured FAs had greater aneurysm size (median size, 4.55 mm [IQR, 3.20-7.55 mm] vs 3.00 mm [IQR, 2.40-5.00 mm]; P = 0.009), larger size ratio (median, 2.72 [IQR, 1.95-4.12] vs 2.23 [1.10-2.87]; P = 0.021) and larger relative size ratio (median, 0.24 [IQR, 0.137-0.358] vs 0.096 [IQR, 0.063-0.129]; P < 0.001) compared to unruptured ones. Only AVM size (OR, 0.92 [95%CI, 0.84-0.99]; P = 0.039) and size ratio (OR, 1.66 [95%CI, 1.07-2.59]; P = 0.024) remained associated with the risk of rupture in multivariable binary logistic regression. Conclusion: Size of pAVM and size ratio of FA to average parent vessel diameter are independent risk factors of FA rupture associated with pAVM.
Keywords: Intracranial Aneurysm, arteriovenous malformation, Posterior Circulation, Subarachnoid Hemorrhage, flow-related aneurysm
Received: 13 Aug 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Wang, Li, Li, Chen, Chekera, Chang, Luo, Li, Li, Lin, Xu, Chen, Li and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhi Chen, zhichen@tmmu.edu.cn
Wen Li, liwenguanyun@163.com
Hua Lu, luhua@njmu.edu.cn
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