Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, China.
J Neurointerv Surg. 2022 Nov;14(11):1112-1117. doi: 10.1136/neurintsurg-2021-018187. Epub 2021 Dec 6.
To explore the hemodynamic changes after embolization of arteriovenous malformations (AVMs) using quantitative digital subtraction angiography (QDSA).
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.
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).
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.
利用定量数字减影血管造影术（QDSA）探讨动静脉畸形（AVM）栓塞后的血流动力学变化。
我们回顾了 74 例接受血管内栓塞治疗的幕上 AVM，并进行了定量血流动力学分析，比较了术前和术后 DSA 中的参数与破裂的相关性。根据栓塞程度将 AVM 进一步分为两组：组 I：0%-50%，组 II：51%-100%。在组间分析中，我们检查了栓塞程度与血流动力学参数变化之间的相关性。
主要供血动脉的峰值时间（TTP）延长（OR 11.836；95%CI 1.388 至 100.948；P=0.024）和病灶的平均通过时间（MTT）缩短（OR 0.174；95%CI 0.039 至 0.766；P=0.021）与 AVM 破裂相关。栓塞后，所有 MTT 均显著延长（P<0.05）。主要供血动脉的半最大值全宽（FWHM）持续时间显著缩短（P<0.001），主要引流静脉的几个血流动力学参数也发生了显著变化（TTP：延长，P=0.005；FWHM：延长，P=0.014；流入梯度：降低，P=0.004；流出梯度：降低，P=0.042）。在亚组分析中，两组的几个 MTT 参数均显著延长（P<0.05），且组 II 的 MTT 增加率大于组 I（P<0.05）。
栓塞可显著改变 AVM 的血流动力学，尤其是当获得 50%以上的栓塞程度时。从血流动力学角度来看，部分栓塞可能会降低 AVM 破裂的风险。
