Newswise — Winner of the Louise Eisenhardt Traveling Scholarship, Sophia F. Shakur, MD, IFAANS, presented her research, Changes in Pulsatility and Resistance Indices of Cerebral Arteriovenous Malformation Feeder Arteries after Embolization and Surgery, during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Embolization reduces flow in cerebral arteriovenous malformations (AVMs) before surgical resection, but changes in pulsatility and resistance indices (PI = [(systolic – diastolic flow velocity)/mean flow velocity], RI = [(systolic – diastolic flow velocity)/systolic flow velocity]) are unknown. The authors measured PI, RI in AVM arterial feeders pre- and post-embolization and/or surgery.
The study reviewed records of patients who underwent AVM embolization and surgical resection at a single institution between 2007-2014, and those patients who had PI, RI and flows obtained using quantitative magnetic resonance angiography were retrospectively reviewed. Hemodynamic parameters were compared between the feeder and contralateral artery pre- and post-embolization/surgery.
32 patients with 48 feeder arteries underwent embolization (mean 1.3 sessions). Another 32 patients with 49 feeder arteries had surgery with/without preoperative embolization. Before any treatment, flow volume rate and mean, systolic, diastolic flow velocities were significantly higher in feeders versus contralateral counterparts, and PI, RI were significantly lower in feeder compared to contralateral vessels. After embolization, mean, systolic and diastolic flow velocities increased significantly, but PI, RI did not change significantly. However, after surgery mean, systolic and diastolic flow velocities within feeders decreased significantly, and PI, RI normalized to match the indices of their contralateral counterparts
Following partial AVM embolization, PI, RI are unchanged, and flow velocities in feeder arteries increase significantly, likely due to redistribution of flow through residual nidus. Complete surgical resection results in normalization of PI, RI and a concomitant decrease in flow velocities.
Author Block: Sophia F. Shakur, MD; Sepideh Amin-Hanjani, MD; Mohamed Abouelleil, BS; Victor Aletich, MD; Fady Charbel, MD; Ali Alaraj, MD (Chicago)
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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