Short occipital circulation time derived from quantitative digital subtraction angiography is associated with headache risk in patients with unruptured brain arteriovenous malformations

Abstract

Purpose

To explored key angiographic markers associated with headache risk in patients with unruptured brain arteriovenous malformations (BAVMs).

Methods

This retrospective study included patients with unruptured, supratentorial BAVMs without prior interventions who underwent digital subtraction angiography between January 2011 and January 2024. The patients were stratified into headache and nonheadache groups on the basis of symptoms at initial presentation. Patient data and angiograms were analyzed to explore BAVM characteristics and quantitative digital subtraction angiography (QDSA) parameters. Data on occipital circulation time—defined as the interval between the bolus arrival time in the cavernous internal carotid artery and that in the occipital vein and measured using lateral DSA ipsilateral to the BAVM—were collected. Multivariate logistic regression was performed to identify key factors associated with BAVM-related headaches.

Results

This study included 93 patients, among whom 50 (53.3 %) presented with headaches. The multivariate analysis revealed that female sex, occipital BAVM location, venous reflux in the superior sagittal sinus, and occipital circulation time <2.37 s were independently associated with BAVM-related headache risk. We developed a model that combined angioarchitectural features and QDSA results; the model exhibited improved performance in determining BAVM-related headache risk (area under the curve: 0.854).

Conclusions

Female sex, occipital BAVM location, venous reflux in the superior sagittal sinus, and a short occipital circulation time are associated with headaches in patients with unruptured BAVM. QDSA can objectively quantify hemodynamic changes in patients with BAVM-related headaches.