Anatomic predictors of neurologic complications in solitary pulmonary arteriovenous malformations: a multicenter...

To identify clinical and imaging predictors of symptomatic neurologic complications in patients with solitary pulmonary arteriovenous malformations (PAVMs).

This multicenter retrospective study included 207 patients with solitary, untreated PAVMs diagnosed by CT between 2004 and 2020. Patients were categorized into neurologic and control groups based on the presence or absence of symptomatic neurologic complications (ischemic stroke or brain abscess) at the time of PAVM diagnosis, with transient ischemic attacks excluded. Of the 207 patients, 36 were in the neurologic group and 171 in the control group. Clinical and CT imaging features-including feeding artery diameter, sac size, sac-to-feeding artery (SF) ratio, morphology, and the presence of intrasaccular thrombus-were compared using univariate analysis.

No significant differences were found in sex, age, PAVM location, PAVM type, or the presence of intrasaccular thrombus. However, the neurologic group had significantly larger feeding artery diameters (median, 3.8 mm [range, 2.0-8.0] vs 3.0 mm [0.9-9.3], p = 0.0023), larger sac sizes (9.9 mm [3.5-26.0] vs 6.5 mm [1.7-39.0], p < 0.0001), and higher SF ratios (2.5 [1.4-4.4] vs 2.0 [1.0-5.8], p = 0.0053). Multi-saccular morphology was also more frequent in the neurologic group (p = 0.0023).

Larger feeding artery diameter, greater sac size, high SF ratio, and multi-saccular morphology were significant predictors of neurologic complications in solitary PAVMs. A 2.0 mm feeder diameter was the minimum associated with neurologic events, supporting its use as a practical threshold for embolization when combined with other high-risk features.

Question It remains unclear which anatomic features of solitary PAVMs are associated with neurologic complications such as ischemic stroke or brain abscess. Findings Larger feeding artery diameter, greater sac size, higher SF artery ratio, and multi-saccular morphology were associated with symptomatic neurologic complications. Clinical relevance Our findings support a 2.0 mm feeder diameter as a practical treatment threshold and may refine embolization criteria by identifying high-risk anatomical features that predispose to neurologic events such as ischemic stroke or brain abscess.