Murayama Y, Massoud T F, Viñuela F
Endovascular Therapy Service, University of California, Los Angeles Medical Center, USA.
Stroke. 1996 Aug;27(8):1365-72. doi: 10.1161/01.str.27.8.1365.
A Doppler guidewire was used to monitor progressive changes in draining vein flow parameters during experimental embolotherapy in a swine arteriovenous malformation (AVM) model.
A microcatheter was positioned superselectively in the main arterial feeder and main draining vein in each of 10 AVM models in swine. With use of the Doppler guidewire, preembolization arterial and venous average peak velocities (APVs) and pulsatility indices were recorded. The device was left in the draining vein during transarterial particulate (in 8 swine) or liquid adhesive (in 2 swine) embolization, and continuous transvenous flow during and after treatment was monitored. Periembolization Doppler flow parameters were correlated qualitatively with angiographic changes in the nidus.
Preembolization draining vein flow was pulsatile, with a mean APV of 38.9 +/- 13.7 cm/s. After embolization, this changed significantly to a less pulsatile or nonpulsatile pattern, with a lower mean APV of 9.2 +/- 4.9 cm/s (P = .0001). A novel expression, the maximum minus the minimum peak velocity (MxPV-MnPV), was used in evaluating the transvenous Doppler spectra. This was reduced significantly after embolization from a mean of 11.1 +/- 3.5 cm/s to 6.7 +/- 2.5 cm/s (P = .0025). Objective periembolization hemodynamic changes were detected in the draining veins earlier than the visually subjective angiographic changes within the nidus.
Transvenous Doppler guidewire assessment of two parameters, APV and MxPV-MnPV, is useful in the hemodynamic evaluation of experimental arteriovenous shunting and may be used for future objective and quantitative monitoring during endovascular AVM embolotherapy.
在猪动静脉畸形（AVM）模型的实验性栓塞治疗过程中，使用多普勒导丝监测引流静脉血流参数的动态变化。
在10个猪AVM模型中，将微导管超选择性地置于主要动脉供血支和主要引流静脉内。使用多普勒导丝记录栓塞前动脉和静脉的平均峰值流速（APV）及搏动指数。在经动脉颗粒栓塞（8头猪）或液体黏合剂栓塞（2头猪）过程中，将该装置留在引流静脉内，监测治疗期间及治疗后的持续静脉血流。栓塞周围的多普勒血流参数与病灶内血管造影变化进行定性关联。
栓塞前引流静脉血流呈搏动性，平均APV为38.9±13.7 cm/s。栓塞后，血流模式显著改变为搏动性减弱或无搏动，平均APV降低至9.2±4.9 cm/s（P = .0001）。一种新的表达式，即最大峰值流速减去最小峰值流速（MxPV-MnPV），用于评估经静脉多普勒频谱。栓塞后该值从平均11.1±3.5 cm/s显著降低至6.7±2.5 cm/s（P = .0025）。在病灶内血管造影出现肉眼可见的主观变化之前，就已在引流静脉中检测到栓塞周围客观的血流动力学变化。
经静脉多普勒导丝评估APV和MxPV-MnPV这两个参数，有助于对实验性动静脉分流进行血流动力学评估，并且可用于未来血管内AVM栓塞治疗期间的客观定量监测。
