Transcranial color-coded Doppler assessment of cerebral arteriovenous malformation hemodynamics in patients treated surgically or with staged embolization

• Published in: Clinical neurology and neurosurgery 2014-01, Vol.116 (C), p.46-53
• Main Authors: Kaspera, Wojciech, Ładziński, Piotr, Larysz, Patrycja, Majchrzak, Henryk, Hebda, Anna, Kopera, Marek, Tomalski, Witold, Ślaska, Aleksandra
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Aging; Arteriovenous malformation; Blood Flow Velocity - physiology; Carotid artery; Cerebral hemodynamics; Cerebrovascular Circulation - physiology; Colorectal cancer; Embolization, Therapeutic - methods; Female; Hemodynamics - physiology; Humans; Intracranial Arteriovenous Malformations - surgery; Male; Medical imaging; Middle Aged; Neurology; Neurosurgery; Neurosurgical Procedures - methods; Patients; Staged embolization; Standard deviation; Surgical management; Transcranial color-coded Doppler sonography; Ultrasonic imaging; Ultrasonography, Doppler, Transcranial - methods; Veins & arteries; Young Adult
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2013.11.001

Abstract Objective The etiology of hemodynamic disturbances following embolization or surgical resection of arteriovenous malformations (AVMs) has not been fully explained. The aim of the study was the assessment of the selected hemodynamic parameters in patients treated for cerebral AVMs using transcranial color-coded Doppler sonography (TCCS). Materials and methods Forty-six adult patients (28 males, 18 females, aged 41 ± 13 years, mean ± SD) diagnosed with AVMs who were consecutively admitted to the Department of Neurosurgery between 2000 and 2012 treated surgically or with staged embolization were enrolled in the study. All patients were examined with TCCS assessing mean flow velocity ( V m ), the pulsatility index (PI) and vasomotor reactivity (VMR) in all main intracranial arteries. The examined parameters were assessed in the vessel groups (feeding, ipsilateral and contralateral to the AVM) and they were compared between the examinations, i.e. at admission, within 24 h after the first embolization or surgical resection (I control), and before the second embolization (II control). Results In feeders which were completely obliterated or surgically resected – I control examination showed a nonsignificant V m decrease. The difference between V m before embolization and II control examination was significant (102.0 ± 47.8 cm/s vs 54.3 ± 19.4 cm/s, p < 0.01). A significant increase in PI (0.72 ± 0.18 vs 0.94 ± 0.24, p < 0.01) and VMR (1.80 ± 0.59 vs 2.78 ± 0.78, p < 0.01) of feeding vessels was observed in I control. No further increase in PI or in VMR was observed. In embolized feeding vessels after partial AVM embolization I control examination showed a significant decrease in V m (116.1 ± 32.6 cm/s vs 93.4 ± 33.0 cm/s, p < 0.01). No further significant decrease in V m was noted. The pulsatility index increased significantly (I control, 0.54 ± 0.11 vs 0.66 ± 0.15, p < 0.01) and then decreased nonsignificantly (II control). No statistically significant differences were found in VMR values between pretreatment, I and II control examinations. Both V m in the ipsilateral internal carotid artery and the ratio of V m of the embolized vessel to V m of the corresponding contralateral vessel were significantly higher in I control examination compared to II control examination (111.8 ± 44.0 cm/s vs 101.3 ± 40.6 cm/s, p < 0.01; 1.63 ± 0.61 vs 1.37 ± 0.62, p < 0.01; respectively). No statistically significant correlation was observed between the decrease in V m or