Burkhardt Jan-Karl, Chen Xiaolin, Winkler Ethan A, Cooke Daniel L, Kim Helen, Lawton Michael T
Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, California, USA.
World Neurosurg. 2017 Aug;104:619-627. doi: 10.1016/j.wneu.2017.04.120. Epub 2017 Apr 27.
Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs.
Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n = 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs.
In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P = 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P < 0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups.
Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements.
文献中缺乏可临床应用的预测动静脉畸形（AVM）破裂的血流动力学危险因素。本研究的目的是利用导管血管造影术识别破裂和未破裂AVM的血流动力学参数。
本研究纳入了患有额叶和颞叶AVM且接受西门子syngo iFlow彩色编码血管造影的患者（n = 71）。分析临床和放射学数据（年龄、性别、斯佩茨勒-马丁[SM]分级及补充的SM分级、破裂状态）以及血流动力学特征（供血动脉、引流静脉、AVM病灶的对比剂平均通过时间[MTT]和脑循环时间[CCT]）。进行单变量分析以比较破裂和未破裂AVM的研究结果。
共分析了35例破裂的AVM和36例未破裂的AVM。破裂和未破裂AVM的临床特征和AVM分级具有可比性。与未破裂的AVM相比，破裂的AVM同侧CCT（5.2秒对4.0秒；P = 0.035）、同侧颈内动脉Tmax与引流静脉窦入口Tmax之间的MTT（3.2秒对2.0秒；P < 0.001）以及静脉流出开始时Tmax与窦入口Tmax之间的MTT（1.6秒对0.7秒；P < 0.0001）显著更长。两组之间病灶的MTT、颈内动脉与供血动脉之间的MTT、静脉窦通道的MTT以及对侧CCT和对照同侧CCT具有可比性。
与未破裂的AVM相比，破裂的AVM静脉引流时间显著延长；这表明AVM引流受限且AVM病灶内血压升高。需要进行前瞻性研究以确定这些测量的预测能力。
