Feeder Artery Aneurysms in Cerebral Arteriovenous Malformations: Demographic, Clinical, and Morphological Associations

BACKGROUND AND OBJECTIVES: Cerebral arteriovenous malformations (AVMs) represent complex vascular lesions with variable anatomical characteristics. The coexistence of feeder artery aneurysms (FAAs) with AVMs adds an additional layer of complexity, influencing patient outcomes and treatment strategies. METHODS: A retrospective review of patients evaluated for cerebral AVMs at our institution from 2000 to 2024 was conducted. Patient demographics, as well as AVM angioarchitectural and hemodynamic parameters were collected and compared between AVMs with and without FAAs. Logistic regression identified independent predictors of FAA presence, and subgroup analyses explored the relationship between FAA presence, rupture presentation, and AVM characteristics. RESULTS: Four hundred thirty-one patients with cerebral AVMs were included. FAAs were present in 20.0% of AVMs and were associated with older age ( P < .001), infratentorial location ( P < .001), larger feeder artery diameter ( P = .001), and hemorrhagic presentation ( P = .002). Logistic regression showed 6× higher odds for FAA in infratentorial AVMs ( P < .001), and subgroup analysis of infratentorial AVMs showed smaller volume ( P = .016), smaller feeder size ( P < .001), and less draining veins ( P < .001) in comparison with supratentorial location. Among ruptured AVMs, FAA-related ruptures occurred in older patients ( P = .004), were more common in infratentorial AVMs ( P < .001), and were associated with smaller AVM volumes ( P = .012), posterior circulation FAAs ( P = .044), and deep venous drainage ( P = .037). Hypertension ( P = .003) and distal FAAs ( P = .036) were more prevalent in FAA-related ruptures, whereas venous stenosis was more frequent in AVM-related ruptures ( P = .050). CONCLUSION: FAAs are associated with distinct angioarchitectural features, particularly in infratentorial AVMs, and are also linked to rupture presentation. Given their unique hemodynamic and anatomical profile, AVMs with FAAs may warrant closer surveillance and a more aggressive treatment approach to mitigate rupture risk and improve patient outcomes.