Case 1 was a 57-year-old female with psoriatic arthritis, recurrent miscarriages, and a Spetzler-Martin grade 3 cAVM with a hypertrophied feeding artery appearing hypoplastic on angiography at the time of cAVM regression. Case 2 was a 71-year-old female with Beurger’s disease, +ANA, and a Spetzler-Martin grade 1 cAVM with remodeling of the feeding artery and exhibited regression 16 years later following multiple strokes. Both patients had refractory focal epilepsy.

Nineteen publications exist, detailing 60 cases of cAVM disappearance. Four cases had an associated hypercoagulable state. Six cases reported feeding artery changes pre or post angiography. Six cases involve intervention not directed at the AVM. No other patterns emerged, as demographics, clinical presentations, cAVM size, anatomy, localization, and timeline of resolution vary widely. Potential factors contributing to cAVM resolution are perifocal edema, thrombosis, medications, and a prothrombotic state.

Spontaneous disappearance of cAVMs without intervention occurs in <1% of cases, primarily in superficial and smaller malformations. Several hypotheses suggest this can occur due to hematologic and mechanical factors. Our cases had the potential risk factor of thrombotic events. Additionally, mechanical findings such as the aneurysms and feeding arteries remodeling may have contributed to hemodynamic changes, further inducing thrombus formation. The shared influence of refractory epilepsy is unknown, but possibly may have also played a role in hemodynamic changes and cAVM resolution.