Changes in pulsatility and resistance indices of cerebral arteriovenous malformation feeder arteries after embolization and surgery

Amin‐Hanjani, Sepideh; Abouelleil, Mohamed; Aletich, Victor; Charbel, Fady T.; Alaraj, Ali

doi:10.1080/01616412.2016.1258970

Cited by 9 publications

(10 citation statements)

References 31 publications

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“…Using quantitative MRA to measure blood flow in cerebral AVMs before and after embolization and surgery, Shakur et al demonstrated that blood flow in the ipsilateral artery decreased and normalized in comparison to the contralateral artery after both embolization and surgery. 30 This study replicates these findings in this cohort of patients treated with SRS. In contrast, Shakur et al demonstrated that pulsatility in the ipsilateral artery increased after only surgery and not embolization.…”

Section: Discussionsupporting

confidence: 81%

“…This study replicates these findings in this cohort of patients treated with SRS. In contrast, Shakur et al demonstrated that pulsatility in the ipsilateral artery increased after only surgery and not embolization 30 . They postulated that redistribution of flow after embolization and maintenance of low pulsatility index may be associated with lower rates of rupture.…”

Section: Discussionmentioning

confidence: 95%

“…In contrast, Shakur et al demonstrated that pulsatility in the ipsilateral artery increased after only surgery and not embolization. 30 They postulated that redistribution of flow after embolization and maintenance of low pulsatility index may be associated with lower rates of rupture. In this study, pulsatility normalized in the feeding artery post-SRS, compared to the contralateral artery, and significantly increased post-SRS compared to pre-SRS.…”

Section: Discussionmentioning

confidence: 99%

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Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging

Srinivas

Retson

Simon

et al. 2020

Magnetic Resonance Imaging

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Stereotactic radiosurgery (SRS) is used to treat cerebral arteriovenous malformations (AVMs). However, early evaluation of efficacy is difficult as structural magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) often does not demonstrate appreciable changes within the first 6 months. The aim of this study was to evaluate the use of four‐dimensional (4D) flow MRI to quantify hemodynamic changes after SRS as early as 2 months. This was a retrospective observational study, which included 14 patients with both pre‐SRS and post‐SRS imaging obtained at multiple time points from 1 to 27 months after SRS. A 3T MRI Scanner was used to obtain T2 single‐shot fast spin echo, time‐of‐flight MRA, and postcontrast 4D flow with three‐dimensional velocity encoding between 150 and 200 cm/s. Post‐hoc two‐dimensional cross‐sectional flow was measured for the dominant feeding artery, the draining vein, and the corresponding contralateral artery as a control. Measurements were performed by two independent observers, and reproducibility was assessed. Wilcoxon signed‐rank tests were used to compare differences in flow, circumference, and pulsatility between the feeding artery and the contralateral artery both before and after SRS; and differences in nidus size and flow and circumference of the feeding artery and draining vein before and after SRS. Arterial flow (L/min) decreased in the primary feeding artery (mean: 0.1 ± 0.07 vs. 0.3 ± 0.2; p < 0.05) and normalized in comparison to the contralateral artery (mean: 0.1 ± 0.07 vs. 0.1 ± 0.07; p = 0.068). Flow decreased in the draining vein (mean: 0.1 ± 0.2 vs. 0.2 ± 0.2; p < 0.05), and the circumference of the draining vein also decreased (mean: 16.1 ± 8.3 vs. 15.7 ± 6.7; p < 0.05). AVM volume decreased after SRS (mean: 45.3 ± 84.8 vs. 38.1 ± 78.7; p < 0.05). However, circumference (mm) of the primary feeding artery remained similar after SRS (mean: 15.7 ± 2.7 vs. 16.1 ± 3.1; p = 0.600). 4D flow may be able to demonstrate early hemodynamic changes in AVMs treated with radiosurgery, and these changes appear to be more pronounced and occur earlier than the structural changes on standard MRI/MRA. Level of Evidence: 4 Technical Efficacy Stage: 1

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging

Srinivas

Retson

Simon

et al. 2020

Magnetic Resonance Imaging

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“…These include time-resolved imaging of contrast kinetics MRA, 17 4D radial acquisition contrast-enhanced MRA (4D rCE-MRA), 19 4D flow MRI using constrained reconstruction (HYPRflow), 16,17 MR-tractography, 29 functional MRI (fMRI), and quantitative MRA. 15,[24][25][26] Time-resolved imaging of contrast kinetics MRA, 4D rCE-MRA, and HYPRflow are particularly useful to characterize the anatomic features of bAVMs. As opposed to DSA, these imaging modalities are noninvasive and in the future may have the potential to provide similar information to DSA.…”

Section: Nonstandard Abbreviations and Acronymsmentioning

confidence: 99%

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Samaniego,

Dabus,

Meyers

et al. 2024

Stroke

Self Cite

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Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.

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“…[12][13][14] Resistance of the vessels is sensitive to the change of flow dynamics according to the downstream structure and could be used to understand the angioarchitecture of shunting diseases. [14][15][16] Therefore, by precisely recording the pressure waveform from the tip of the microcatheter, it could be possible not only to measure the mean pressure but also to extract useful information by analyzing the waveform itself.…”

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confidence: 99%

Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

Shimoda¹,

Sonobe²,

Niizuma

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND An arteriovenous fistula is an abnormal arteriovenous shunt between an artery and a vein, which often leads to venous congestion in the central nervous system. The blood flow near the fistula is different from normal artery flow. A novel method to detect the abnormal shunting flow or pressure near the fistula is needed. OBSERVATIONS A 76-year-old woman presented to the authors’ institute with progressive right upper limb weakness. Right vertebral angiography showed a fistula between the right extracranial vertebral artery (VA) and the right vertebral venous plexus at the C7 level. The patient underwent endovascular treatment for shunt flow reduction. Before the procedure, blood pressures were measured at the proximal VA, distal VA near the fistula, and just at the fistula and drainer using a microcatheter. The blood pressure waveforms were characteristically different in terms of resistance index, half-decay time, and appearance of dicrotic notch. The fistula was embolized with coils and N-butyl cyanoacrylate solution. LESSONS During endovascular treatment, the authors were able to digitally record the vascular pressure waveform from the tip of the microcatheter and succeeded in calculating several parameters that characterize the shunting flow. Furthermore, these parameters could help recognize the abnormal blood flow, allowing a safer endovascular surgery.

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Changes in pulsatility and resistance indices of cerebral arteriovenous malformation feeder arteries after embolization and surgery

Cited by 9 publications

References 31 publications

Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging

Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

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