Unruptured brain arteriovenous malformation risk stratification

Cerebral arteriovenous malformations (AVMs) are an uncommon type of central nervous system vascular anomaly that have the potential to rupture and cause intracranial hemorrhage. AVM hemorrhagic risk assessment has been mainly based on anatomical features derived from imaging; the most recent focus on AVM hemodynamics, vessel wall imaging, and molecular analysis of the inflammatory response, provide new insights into the hemorrhagic risk stratification. The greater data availability provided by innovative imaging techniques and biological analysis of biomarkers and genetic polymorphism further demonstrates the existence of a complex interaction between anatomically altered vasculature, non-physiological hemodynamics, and inflammatory molecular activity. The accurate prediction of cerebral AVM rupture, essential to guide the management decision by comparing the risk of observation to the risk of intervention, has yet to be solved. This review of several studies aims to summarize the current evidence on brain AVM rupture risk stratification.