Hemodynamic Changes in Arterial Feeders and Draining Veins during Embolotherapy of Arteriovenous Malformations: An Experimental Study in a Swine Model

Hemodynamic Changes in Arterial Feeders and Draining Veins during Embolotherapy of Arteriovenous... AbstractOBJECTIVE: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 - Vcd, 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Hemodynamic Changes in Arterial Feeders and Draining Veins during Embolotherapy of Arteriovenous Malformations: An Experimental Study in a Swine Model

Hemodynamic Changes in Arterial Feeders and Draining Veins during Embolotherapy of Arteriovenous Malformations: An Experimental Study in a Swine Model

EXPERIMENTAL STUDIES Hemodynamic Changes in Arterial Feeders and Draining Veins during Embolotherapy of Arteriovenous Malformations: An Experimental Study in a Swine Model Yuichi Murayama, M.D., Tarik F. Massoud, M.D., Fernando Vinuela, M.D. Division of Interventional Neuroradiology and Leo G. Rigler Radiological Research Center, University of California, Los Angeles School of Medicine, Los Angeles, California O BJECTIVE: 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. M ETHO DS: Carotid-jugular fistula-type AVM models were surgically created in eight swine. Pre- and postemboli­ zation 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 (V„ - Vod), was also used in evaluating the transvenous Doppler spectra. Pre- and postembolization hemodynamic param­ eters 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 ± 1 1 . 4 cm per second. Postembolization, this changed to a less/nonpulsatile pattern (Vs - Vcd, 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...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199807000-00064
Publisher site
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Abstract

AbstractOBJECTIVE: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 - Vcd, 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.

Journal

NeurosurgeryOxford University Press

Published: Jul 1, 1998

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