Document Detail


Hemodynamic changes in arterial feeders and draining veins during embolotherapy of arteriovenous malformations: an experimental study in a swine model.
MedLine Citation:
PMID:  9657195     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Transcatheter assessment of changes in draining vein (DV) flow velocity has been proposed recently as a potentially useful procedure for hemodynamic monitoring of the progression of embolotherapy in cerebral arteriovenous malformations (AVMs). We compared and contrasted changes in hemodynamic parameters of arterial feeders (AFs) and DVs during experimental AVM embolotherapy. METHODS: Carotid-jugular fistula-type AVM models were surgically created in eight swine. Pre- and postembolization transcatheter mean AF and DV pressures, DV-time average spectral peak velocity, and AF and DV pulsatility indices were assessed. An expression, the peak systolic velocity minus end-diastolic velocity (Vs - Ved), was also used in evaluating the transvenous Doppler spectra. Pre- and postembolization hemodynamic parameters were compared statistically. RESULTS: Pre-embolization DV flow was pulsatile (Vs - Ved, 12 +/- 4.8 cm/s), with a mean DV velocity of 39.3 +/- 11.4 cm per second. Postembolization, this changed to a less/nonpulsatile pattern (Vs - Ved, 5.4 +/- 2.7 cm/s; P = 0.0035) with a lower mean DV-average spectral peak velocity of 7.0 +/- 3.1 cm per second (P = 0.0001). The mean DV pressure was also reduced from 52.0 +/- 8.2 to 45.5 +/- 8.7 mm Hg (P = 0.0023). The mean AF pressure increased from a mean of 79.5 +/- 15.5 to 96.8 +/- 16.2 mm Hg (P = 0.0004). The DV pulsatility index values also increased from a mean of 0.3 +/- 0.2 to 1.1 +/- 0.5 (P = 0.0003). Periembolization objective hemodynamic changes were detected in the DVs earlier than were the visually subjective angiographic changes observed within the nidus. CONCLUSION: This preliminary study indicates that transvenous assessment of average spectral peak velocity and wave pattern (Vs - Ved) may be useful in the hemodynamic evaluation of AVM shunting. The convergence of these two parameters to a range less than 10 cm per second after nidus embolization may afford a theoretical advantage over AF pressure measurements when used for objective and quantitative monitoring of endovascular embolotherapy.
Authors:
Y Murayama; T F Massoud; F Viñuela
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Neurosurgery     Volume:  43     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-09-30     Completed Date:  1998-09-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  96-104; discussion 104-6     Citation Subset:  IM    
Affiliation:
Division of Interventional Neuroradiology and Leo G. Rigler Radiological Research Center, University of California, Los Angeles School of Medicine, 90024, USA.
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MeSH Terms
Descriptor/Qualifier:
Angiography
Animals
Arteries / physiopathology
Blood Flow Velocity / physiology
Disease Models, Animal
Embolization, Therapeutic*
Female
Hemodynamics / physiology*
Intracranial Arteriovenous Malformations / physiopathology,  therapy*
Laser-Doppler Flowmetry
Male
Pulsatile Flow / physiology
Risk Factors
Rupture, Spontaneous
Signal Processing, Computer-Assisted
Swine
Vascular Resistance / physiology
Veins / physiopathology
Venous Pressure / physiology
Grant Support
ID/Acronym/Agency:
R01HL/NS52352-01A1/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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