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Hemorrhagic stroke
Original research
Quantitative evaluation of hemodynamics after partial embolization of brain arteriovenous malformations
  1. Zhipeng Li1,
  2. Yu Chen1,
  3. Pingting Chen2,
  4. Ruinan Li1,
  5. Li Ma1,
  6. Debin Yan1,
  7. Haibin Zhang1,
  8. Heze Han1,
  9. Yang Zhao3,
  10. Yukun Zhang3,
  11. Xiangyu Meng4,
  12. Hengwei Jin4,
  13. Youxiang Li4,
  14. Xiaolin Chen1,5,6,
  15. Yuanli Zhao1,3,5,6
  1. 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2 College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China
  3. 3 Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
  4. 4 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
  5. 5 China National Clinical Research Center for Neurological Disease, Beijing, China
  6. 6 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  1. Correspondence to Dr Yuanli Zhao, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing 100070, China; zhaoyuanli{at}126.com; Dr Xiaolin Chen; xiaolinchen488{at}hotmail.com

Abstract

Background To explore the hemodynamic changes after embolization of arteriovenous malformations (AVMs) using quantitative digital subtraction angiography (QDSA).

Methods We reviewed 74 supratentorial AVMs that underwent endovascular embolization and performed a quantitative hemodynamic analysis comparing parameters in pre- and post-operative DSA in correlation with rupture. The AVMs were further divided into two subgroups based on the embolization degree: Group I: 0%–50%, Group II: 51%–100%. In the intergroup analysis, we examined the correlations between embolization degree and hemodynamic parameter changes.

Results A longer time to peak (TTP) of the main feeding artery (OR 11.836; 95% CI 1.388 to 100.948; P=0.024) and shorter mean transit time (MTT) of the nidus (OR 0.174; 95% CI 0.039 to 0.766; P=0.021) were associated with AVM rupture. After embolization, all MTTs were significantly prolonged (P<0.05). The full width at half maximum (FWHM) duration of the main feeding artery was significantly shortened (P<0.001), and several hemodynamic parameters of the main draining vein changed significantly (TTP: prolonged, P=0.005; FWHM: prolonged, P=0.014; inflow gradient: decreased, P=0.004; outflow gradient: decreased, P=0.042). In the subgroup analysis, several MTT parameters were significantly prolonged in both groups (P<0.05), and the MTT increase rate in Group II was greater than in Group I (P<0.05).

Conclusions Embolization can significantly change the hemodynamics of AVMs, especially when an embolization degree >50% is obtained. Partial embolization may reduce the AVM rupture risk in hemodynamics perspective.

  • arteriovenous malformation
  • embolic
  • blood flow

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/neurintsurg-2021-018187

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Footnotes

    • ZL and YC contributed equally.

    • Contributors YC and ZL conceived the idea, designed the paper, and wrote the manuscript. LM, PC, and RL performed the statistical analysis. ZL, DY, HZ, HH, YaZ, and YukZ collected the data and designed the paper. XM and HJ performed the QDSA analysis. YL, XC, and YuaZ funded the study, critically revised the manuscript and approved the final manuscript as submitted. YuaZ is the guarantor. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This study was financially supported by the National Key R&D Program (2020YFC2004701 to Xiaolin Chen), Natural Science Foundation of China (81571110, 81 771 234 to Yuanli Zhao; 81 500 995 to Xiaolin Chen; 81 801 140 to Li Ma), Bai Qian Wan Talent Plan (2017A07 to Yuanli Zhao), and Beijing Municipal Administration of Hospital Incubating Program (PX2016034).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.