You are here

  • Home
  • Online First
  • Overloaded transnidal pressure gradient as the hemodynamic mechanism leading to arteriovenous malformation rupture: a quantitative analysis using intravascular pressure monitoring and color-coded digital subtraction angiography

Article Text

Article menu
Download PDFPDF
Vascular neurology
Overloaded transnidal pressure gradient as the hemodynamic mechanism leading to arteriovenous malformation rupture: a quantitative analysis using intravascular pressure monitoring and color-coded digital subtraction angiography
  1. Yukun Zhang1,2,
  2. Yu Chen1,3,
  3. Ruinan Li1,3,
  4. Li Ma1,4,
  5. Heze Han1,3,
  6. Zhipeng Li1,3,
  7. Haibin Zhang1,3,
  8. Kexin Yuan1,3,
  9. Yang Zhao2,
  10. Weitao Jin2,
  11. Pingting Chen5,
  12. Wanting Zhou6,
  13. Xun Ye1,3,
  14. Youxiang Li7,
  15. Shuo Wang1,3,
  16. Xiaolin Chen1,3,
  17. Yuanli Zhao1,3
  1. 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Department of Neurosurgery, Peking University International Hospital, Beijing, China
  3. 3China National Clinical Research Center for Neurological Diseases, Beijing, China
  4. 4Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  5. 5College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China
  6. 6Department of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
  7. 7Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
  1. Correspondence to Dr Yuanli Zhao, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing 100079, China; zhaoyuanli{at}126.com; Dr Xiaolin Chen, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Bejing 100070, People's Republic of China; cxl_bjtth{at}163.com

Abstract

Background The hemodynamics of brain arteriovenous malformations (AVMs) may have implications for hemorrhage. This study aimed to explore the hemodynamics of ruptured AVMs by direct microcatheter intravascular pressure monitoring (MIPM) and indirect quantitative digital subtraction angiography (QDSA).

Methods We recruited patients with AVMs at a tertiary neurosurgery center from October 2020 to March 2023. In terms of MIPM, we preoperatively super-selected a predominant feeding artery and main draining vein through angiography to measure intravascular pressure before embolization. In processing of QDSA, we adopted previously standardized procedure for quantitative hemodynamics analysis of pre-embolization digital subtraction angiography (DSA), encompassing main feeding artery, nidus, and the main draining vein. Subsequently, we investigated the correlation between AVM rupture and intravascular pressure from MIPM, as well as hemodynamic parameters derived from QDSA. Additionally, we explored the interrelationships between hemodynamic indicators in both dimensions.

Results After strict screening of patients, our study included 10 AVMs (six ruptured and four unruptured). We found that higher transnidal pressure gradient (TPG) (53.00±6.36 vs 39.25±8.96 mmHg, p=0.042), higher feeding artery pressure (FAP) (72.83±5.46 vs 65.00±6.48 mmHg, p=0.031) and higher stasis index of nidus (3.54±0.73 vs 2.43±0.70, p=0.043) were significantly correlated with AVM rupture. In analysis of interrelationships between hemodynamic indicators in both dimensions, a strongly positive correlation (r=0.681, p=0.030) existed between TPG and stasis index of nidus.

Conclusions TPG and FAP from MIPM platform and nidus stasis index from QDSA platform were correlated with AVM rupture, and both were positively correlated, suggesting that higher pressure load within nidus may be the central mechanism leading to AVM rupture.

  • Arteriovenous Malformation
  • Blood Pressure
  • Catheter
  • Hemorrhage
  • Blood Flow

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-021348

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Footnotes

    • Twitter @LimaNeuro

    • YZ and YC contributed equally.

    • Contributors Yua Z as the guarantor responsible for the overall content of the study. Yuk Z, Yua Z and XC conceptualized and designed the study. Yuk Z, YC, RL, LM, HH, ZL, HZ, KY, PC, WZ, Yan Z, WJ, XY, and YL collected the data. Yuk Z, YC, RL, LM, HH, and ZL performed the statistical analysis. Yuk Z and YC wrote the manuscript. Yuk Z, YC, RL, LM, HH, ZL, HZ, KY, Yan Z, WJ, XY, YL, SW and Yua Z assessed the clinical and radiological follow-up results. YC, Yuk Z, WZ, XC, and Yua Z funded the study. Yuk Z, YC, XC and Yua Z critically revised the manuscript and approved the final manuscript as submitted. 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 supported by the Natural Science Foundation of China (Grant No. 82202244 to Yu Chen, 81771234 and 82071302 to Yuanli Zhao), the Science Foundation of Peking University International Hospital (Grant No. YN2021QN12 to Yukun Zhang), and the National Key Research and Development Program of China (Grant No. 2021YFC2501101 to Xiaolin Chen, and No. 2022YFB4702800 to Yuanli Zhao).

    • 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.