Delayed Venous Drainage in Ruptured Arteriovenous Malformations Based on Quantitative Color-Coded Digital Subtraction Angiography
Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs. Patients with frontal and temporal AVMs and Siem...
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| Vydáno v: | World neurosurgery Ročník 104; s. 619 - 627 |
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Elsevier Inc
01.08.2017
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| ISSN: | 1878-8750, 1878-8769, 1878-8769 |
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| Abstract | Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs.
Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n = 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs.
In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P = 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P < 0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups.
Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements. |
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| AbstractList | Abstract Objective Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to identify hemodynamic parameters in ruptured and unruptured AVMs based on catheter angiography. Methods Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n=71). Clinical and radiological data (age, gender, Spetzler-Martin (SM) and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time (MTT) of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time (CCT)) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs. Results In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs 4.0sec, p=0.035), MTT between Tmax of ipsilateral internal carotid artery (ICA) and Tmax of sinus entry of the draining vein (3.2 vs 2.0 sec, p<0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs 0.7 sec, p<0.0001) were significantly longer in ruptured compared to unruptured AVMs. MTTs of nidus, between ICA and feeding artery, of venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups. Conclusions Ruptured AVMs have significantly prolonged venous drainage times compared to unruptured AVMs, which suggest restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements. Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs.OBJECTIVEClinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs.Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n = 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs.METHODSPatients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n = 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs.In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P = 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P < 0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups.RESULTSIn total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P = 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P < 0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups.Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements.CONCLUSIONSRuptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements. Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs. Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n = 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs. In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P = 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P < 0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups. Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements. |
| Author | Lawton, Michael T. Burkhardt, Jan-Karl Chen, Xiaolin Kim, Helen Winkler, Ethan A. Cooke, Daniel L. |
| Author_xml | – sequence: 1 givenname: Jan-Karl surname: Burkhardt fullname: Burkhardt, Jan-Karl organization: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA – sequence: 2 givenname: Xiaolin surname: Chen fullname: Chen, Xiaolin organization: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA – sequence: 3 givenname: Ethan A. surname: Winkler fullname: Winkler, Ethan A. organization: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA – sequence: 4 givenname: Daniel L. surname: Cooke fullname: Cooke, Daniel L. organization: Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA – sequence: 5 givenname: Helen surname: Kim fullname: Kim, Helen organization: Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA – sequence: 6 givenname: Michael T. surname: Lawton fullname: Lawton, Michael T. email: Michael.Lawton@ucsf.edu organization: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA |
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| Keywords | MRI ICA J MTT ROI ICH Ruptured AVM Mean transit time DV DSA S CCT AVM IVH SM Hemodynamics Unruptured AVM FA iCCT Arteriovenous malformation cCCT ruptured and unruptured AVMs arteriovenous malformation (AVM) mean transit time hemodynamics |
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| Snippet | Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to... Abstract Objective Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of... |
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| SubjectTerms | Adolescent Adult Aged Angiography, Digital Subtraction Arteriovenous malformation AVM Blood Flow Velocity - physiology Cerebrovascular Circulation - physiology Child Child, Preschool Female Hemodynamics Hemodynamics - physiology Humans Intracranial Arteriovenous Malformations - diagnostic imaging Intracranial Arteriovenous Malformations - physiopathology Intracranial Arteriovenous Malformations - surgery Male Mean transit time Middle Aged Neurosurgery Phlebography Prognosis Radiographic Image Enhancement Ruptured AVM Unruptured AVM Young Adult |
| Title | Delayed Venous Drainage in Ruptured Arteriovenous Malformations Based on Quantitative Color-Coded Digital Subtraction Angiography |
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