Remodeling of the feeding arterial system after surgery for resection of brain arteriovenous malformations: an observational study

Michael Kerin Morgan, Mathew Guilfoyle, Ramez Kirollos, Gillian Z. Heller

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. Objective: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. Methods: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery. The preoperative FA/IC ratio (FA/IC preAVM) was compared with the first postoperative FA/IC ratio (FA/IC postAVM). Normal FA/IC ratio (FA/IC normal) was established from matched arteries in the contralateral hemisphere to the AVM. Results: Eighty-six patients were analyzed for postoperative DSA performed a median 4 d after resection. From the interval-censored proportional hazards regression analysis, FA/IC preAVM (hazard ratio of 0.0006; 95% confidence interval: 0.00-0.21; P = .013) and maximum AVM diameter (hazard ratio of 0.47; 95% confidence interval: 0.23-0.95; P = .036) were significant in time to return to normal. These 2 factors were poorly correlated with each other (r = 0.41). AVMs with FA/IC preAVMs <0.57 combined with a diameter <3.0 cm normalize within 7 d in more than 50% of cases. Any other combination of ratio and size has fewer than 20% normalizing within 7 d (log rank P < .001). Conclusion: FA/IC preAVM and AVM size are both important in predicting the time taken for return to normal feeding arterial system on DSA after AVM resection.

LanguageEnglish
Pages84-94
Number of pages11
JournalNeurosurgery
Volume84
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Arteriovenous Malformations
Observational Studies
Internal Carotid Artery
Arteries
Brain
Digital Subtraction Angiography
Confidence Intervals
Postoperative Hemorrhage

Keywords

  • brain
  • Arteriovenous malformation (AVM)
  • surgery
  • artery
  • laminar wall shear stress

Cite this

@article{fc7015fbd77a45429a1619618b5b6ce8,
title = "Remodeling of the feeding arterial system after surgery for resection of brain arteriovenous malformations: an observational study",
abstract = "Background: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. Objective: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. Methods: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery. The preoperative FA/IC ratio (FA/IC preAVM) was compared with the first postoperative FA/IC ratio (FA/IC postAVM). Normal FA/IC ratio (FA/IC normal) was established from matched arteries in the contralateral hemisphere to the AVM. Results: Eighty-six patients were analyzed for postoperative DSA performed a median 4 d after resection. From the interval-censored proportional hazards regression analysis, FA/IC preAVM (hazard ratio of 0.0006; 95{\%} confidence interval: 0.00-0.21; P = .013) and maximum AVM diameter (hazard ratio of 0.47; 95{\%} confidence interval: 0.23-0.95; P = .036) were significant in time to return to normal. These 2 factors were poorly correlated with each other (r = 0.41). AVMs with FA/IC preAVMs <0.57 combined with a diameter <3.0 cm normalize within 7 d in more than 50{\%} of cases. Any other combination of ratio and size has fewer than 20{\%} normalizing within 7 d (log rank P < .001). Conclusion: FA/IC preAVM and AVM size are both important in predicting the time taken for return to normal feeding arterial system on DSA after AVM resection.",
keywords = "brain, Arteriovenous malformation (AVM), surgery, artery, laminar wall shear stress",
author = "Morgan, {Michael Kerin} and Mathew Guilfoyle and Ramez Kirollos and Heller, {Gillian Z.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/neuros/nyy007",
language = "English",
volume = "84",
pages = "84--94",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "OXFORD UNIV PRESS INC",
number = "1",

}

Remodeling of the feeding arterial system after surgery for resection of brain arteriovenous malformations : an observational study. / Morgan, Michael Kerin; Guilfoyle, Mathew; Kirollos, Ramez; Heller, Gillian Z.

In: Neurosurgery, Vol. 84, No. 1, 01.01.2019, p. 84-94.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Remodeling of the feeding arterial system after surgery for resection of brain arteriovenous malformations

T2 - Neurosurgery

AU - Morgan, Michael Kerin

AU - Guilfoyle, Mathew

AU - Kirollos, Ramez

AU - Heller, Gillian Z.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. Objective: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. Methods: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery. The preoperative FA/IC ratio (FA/IC preAVM) was compared with the first postoperative FA/IC ratio (FA/IC postAVM). Normal FA/IC ratio (FA/IC normal) was established from matched arteries in the contralateral hemisphere to the AVM. Results: Eighty-six patients were analyzed for postoperative DSA performed a median 4 d after resection. From the interval-censored proportional hazards regression analysis, FA/IC preAVM (hazard ratio of 0.0006; 95% confidence interval: 0.00-0.21; P = .013) and maximum AVM diameter (hazard ratio of 0.47; 95% confidence interval: 0.23-0.95; P = .036) were significant in time to return to normal. These 2 factors were poorly correlated with each other (r = 0.41). AVMs with FA/IC preAVMs <0.57 combined with a diameter <3.0 cm normalize within 7 d in more than 50% of cases. Any other combination of ratio and size has fewer than 20% normalizing within 7 d (log rank P < .001). Conclusion: FA/IC preAVM and AVM size are both important in predicting the time taken for return to normal feeding arterial system on DSA after AVM resection.

AB - Background: Avoiding the risk of postoperative hemorrhage after brain arteriovenous malformation (AVM) resection involves aggressive blood pressure control. Remodeling of the feeding arterial system is critical in reducing this risk. Objective: To investigate factors predicting time to return to normal on digital subtraction angiography (DSA) after AVM resection. Methods: For AVM in which the largest feeding artery (FA) on DSA was in the anterior circulation, the preoperative and postoperative diameter of the FA were compared with the diameter of the internal carotid artery (IC) immediately proximal to the posterior communicating artery. The preoperative FA/IC ratio (FA/IC preAVM) was compared with the first postoperative FA/IC ratio (FA/IC postAVM). Normal FA/IC ratio (FA/IC normal) was established from matched arteries in the contralateral hemisphere to the AVM. Results: Eighty-six patients were analyzed for postoperative DSA performed a median 4 d after resection. From the interval-censored proportional hazards regression analysis, FA/IC preAVM (hazard ratio of 0.0006; 95% confidence interval: 0.00-0.21; P = .013) and maximum AVM diameter (hazard ratio of 0.47; 95% confidence interval: 0.23-0.95; P = .036) were significant in time to return to normal. These 2 factors were poorly correlated with each other (r = 0.41). AVMs with FA/IC preAVMs <0.57 combined with a diameter <3.0 cm normalize within 7 d in more than 50% of cases. Any other combination of ratio and size has fewer than 20% normalizing within 7 d (log rank P < .001). Conclusion: FA/IC preAVM and AVM size are both important in predicting the time taken for return to normal feeding arterial system on DSA after AVM resection.

KW - brain

KW - Arteriovenous malformation (AVM)

KW - surgery

KW - artery

KW - laminar wall shear stress

UR - http://www.scopus.com/inward/record.url?scp=85059287300&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyy007

DO - 10.1093/neuros/nyy007

M3 - Article

VL - 84

SP - 84

EP - 94

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -