Orlov Kirill, Panarin Vyacheslav, Krivoshapkin Alexey, Kislitsin Dmitry, Berestov Vadim, Shayakhmetov Timur, Gorbatykh Anton
Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia.
Interv Neuroradiol. 2015 Feb;21(1):101-7. doi: 10.15274/inr-2014-10096.
Endovascular embolization is an important modality in the treatment of brain AVMs. Nowadays staged embolization is the method of choice for the prevention of perioperative hemorrhagic complications. Current theory suggests that simultaneous occlusion of more than 60% of AVM volume induces significant redistribution local blood flow. That, in turn, may lead to hemorrhage due to AVM rupture. Aside from angiographic findings, there is still no method that predicts the degree of safe partial embolization. Intraluminal measurement of flow velocity and pressure in the vicinity of the AVM nidus might allow detecting the changes in local hemodynamics. That can provide a valuable data and shed the light on the origin of vascular catastrophes. Ten patients underwent 12 embolization sessions with intraluminal flow velocity and pressure monitoring. The measurements were performed by dual-sensor guidewire. The "Combomap" (Volcano) system with Combowire microguidewires was chosen for measurements, as there is a documented experience of safe use of said guidewires in the cerebral vasculature. The findings observed during the study matched empirical data as well as the current physiological hypothesis of AVM hemorrhage. In conjunction with DSA runs, intraluminal flow velocity and pressure monitoring has the potential to become a valuable tool in AVM treatment.
血管内栓塞是治疗脑动静脉畸形（AVM）的一种重要方式。如今，分期栓塞是预防围手术期出血并发症的首选方法。目前的理论认为，同时闭塞超过60%的AVM体积会导致局部血流显著重新分布。进而可能因AVM破裂导致出血。除了血管造影结果外，目前尚无预测安全部分栓塞程度的方法。在AVM病灶附近进行腔内流速和压力测量可能有助于检测局部血流动力学的变化。这可以提供有价值的数据，并揭示血管灾难的根源。10例患者接受了12次伴有腔内流速和压力监测的栓塞治疗。测量由双传感器导丝完成。选择带有Combowire微导丝的“Combomap”（Volcano）系统进行测量，因为有文献记载该导丝在脑血管系统中使用安全。研究期间观察到的结果与经验数据以及当前关于AVM出血的生理假设相符。结合数字减影血管造影（DSA）检查，腔内流速和压力监测有可能成为AVM治疗中的一种有价值的工具。
