Quantitative evaluation of arteriovenous malformation hemodynamic changes after endovascular treatment using parametric color coding: A case series study

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Brain arteriovenous malformations (AVMs) are complex vascular lesions. Endovascular treatment results are usually measured by calculating the volume reduction of the lesions. Nevertheless, vascular flow quantification seems a more physiologically accurate way of measuring endovascular results. We evaluated the use of parametric color coding (PCC) with digital subtraction angiography (DSA), in order to determine the feasibility of PCC to detect and measure the impact of AVM endovascular treatment-induced changes using real-time hemodynamic parameters. </jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p> Supratentorial brain AVM treatment was evaluated in 29 patients over the course of 38 sessions. Using regions of interest (ROIs) at the carotid siphon, arterial feeder, drainage vein and venous sinus, we found significant increase in time to peak (TTP) values at the arterial feeder, drainage vein and venous sinus. We compared TTP in four different embolization volume groups: I (0–25%), II (26–50%), III (51–75%) and IV (76–100%). We found significant differences between groups and a moderate correlation between embolization percentages, as well as an increase in TTP at the main vein ROI; but not in the arterial side or sinus. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Brain AVM endovascular treatment results can be quantified in vivo with PCC. PCC is capable of detecting hemodynamic changes after brain AVM endovascular treatment, that may reflect flow drop, and it is correlated with volume embolization. </jats:p></jats:sec>

Transdural Blood Supply in Cerebral Arteriovenous Malformations: A Systematic Evaluation of Angioarchitecture

“…Patients were divided into 3 groups following the distribution of angiographic peculiarities and adapting recently suggested thresholds to quantify interventional AVM embolization volumes ( Table 1 and Fig 1). 11 In case of an overlap of different perfusion patterns or distinct feeding varieties in 1 individual, the following grade was applied. Furthermore, flow rates for both the ICA and ECA supply were classified as suggested by Koo et al 5 The flow rate was classified as high if the draining vein was seen at the same time or 1 frame after visualization of the nidus.…”

Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility

“…To date, color-coded quantitative DSA, rather than quantitative fluoroscopy, has been the subject of all clinical investigations resulting from these technical advances. ese studies have investigated a variety of functional parameters, with the aim of extracting objective hemodynamic data from DSA imaging during peripheral arterial and cerebrovascular interventions [6,9,12,[15][16][17][18][19]. Kostrzewa et al investigated FWHM and TTP as parameters for treatment evaluation of SFA and AP lesions, demonstrating that both parameters could be used to assess treatment success independent of ABI value [6].…”

Risk factors for hemorrhage of brain arteriovenous malformation

“…109,110 These studies are promising, and more recent work has expanded the technology to 3D datasets 111 and treatment assesments. 73 More work needs to be done validating the parametric color-coding method in addition to bAVM hemodynamics and natural history in general.…”

“…There is evidence of agreement between the modalities on this measure; for example, Brunozzi et al and Shakur et al reported correlation between MR‐based flow analysis and DSA‐based contrast time‐density curves, with the former also noting that ICH presentation was more common in those with decreased venous transit times and the latter decreased MTT and seizure presentation . These studies are promising, and more recent work has expanded the technology to 3D datasets and treatment assesments . More work needs to be done validating the parametric color‐coding method in addition to bAVM hemodynamics and natural history in general.…”

“…Alternatively, we also have uncertainty of posttherapeutic ICH, such as after microsurgical, embolization, or gamma knife treatments . Demonstrating flow parameters preintervention that elevate posttreatment risk could help direct patients to alternative therapies and/or different postsurgical management . Research into both of these clinical scenarios has enlisted hemodynamic metrics to help explain such hemorrhagic episodes with varying degrees of success.…”