Patient-Specific Blood Flow Analysis for Cerebral Arteriovenous Malformation Based on Digital Subtraction Angiography Images

Abstract

Real-time digital subtraction angiography (DSA) is capable of revealing the cerebral vascular morphology and blood flow perfusion patterns of arterial venous malformations (AVMs). In this study, we analyze the DSA images of a subject-specific left posterior AVM case and customize a generic electric analog model for cerebral circulation accordingly. The generic model consists of electronic components representing 49 major cerebral arteries and veins, and yields their blood pressure and flow rate profiles. The model was adapted by incorporating the supplying and draining patterns of the AVM to simulate some typical AVM features such as the blood "steal" syndrome, where the flow rate in the left posterior artery increases by almost three times (∼300 ml/min vs 100 ml/min) compared with the healthy case. Meanwhile, the flow rate to the right posterior artery is reduced to ∼30 ml/min from 100 ml/min despite the presence of an autoregulation mechanism in the model. In addition, the blood pressure in the draining veins is increased from 9 to 22 mmHg, and the blood pressure in the feeding arteries is reduced from 85 to 30 mmHg due to the fistula effects of the AVM. In summary, a first DSA-based AVM model has been developed. More subject-specific AVM cases are required to apply the presented in silico model, and in vivo data are used to validate the simulation results.

Management of Symptomatic Hemorrhage From a Developmental Venous Anomaly

“…In our case, the rapid onset of severe symptoms and the dangerous size of the hemorrhage, in addition to the evidence of previous chronic bleeds, prompted resection of the hemorrhaging DVA with careful preservation of non-hemorrhagic venous structures. Although our preoperative assessment and the urgent clinical context prompted surgical treatment for a presumed hemorrhagic meningioma, additional preoperative DSA imaging would have been useful to better exclude AVM, and we support the literature wherein such a workup is recommended [18,19]. Postoperatively, there was no evidence of infarction and over one year postoperatively, the patient reports feeling nearly 100% recovered.…”

Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

“…[18][19][20][21][22] The dicrotic notch is usually clearly observed at the level of the VA in normal conditions. 23 Although the dicrotic notch was observed at the origin of the VA in this case, it gradually decreased as the recording point moved toward the shunting fistula and completely disappeared at the shunting point and drainers. This phenomenon could be explained by the fact that resistance downstream of the shunting fistula is decreased compared with that in normal arteries, which have a normal resistance.…”

Pericytes and vascular smooth muscle cells in central nervous system arteriovenous malformations

“…AVMs are characterized, in part, by abnormally high blood flow through AV shunts. The altered hemodynamics are predicted to affect endothelial cells directly, in response to increased blood flow Frontiers in Physiology frontiersin.org and shear stress (Carlson et al, 2005;Murphy et al, 2014;Zhang et al, 2020). In turn, mural cell coverage of microvessels may increase, perhaps in response to a mechanical cue (vessel wall stretch) that promotes mural cell differentiation and maturation (Van Gieson et al, 2003).…”