Use of Quantitative Magnetic Resonance Angiography to Stratify Stroke Risk in Symptomatic Vertebrobasilar Disease

Amin‐Hanjani, Sepideh; Du, Xinjian; Zhao, Ming; Walsh, Katherine; Malisch, Tim W.; Charbel, Fady T.

doi:10.1161/01.str.0000166195.63276.7c

Cited by 140 publications

(109 citation statements)

References 28 publications

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“…[6][7][8][13][14][15][16][17] Before any treatment, mean WSS among 48 feeder arteries in our study was significantly higher compared with the mean WSS in the contralateral vessel (29.7±12.0 dynes/cm 2 versus 23.3±11.0 dynes/ cm 2 ; P=0.007). This result reveals that cerebral AVMs are a high WSS pathology, which disputes Rossitti and Svendsen's hypothesis that WSS in arteries supplying AVMs is the same as in arteries within normal brain parenchyma.…”

Section: Discussioncontrasting

confidence: 49%

Changes in Wall Shear Stress of Cerebral Arteriovenous Malformation Feeder Arteries After Embolization and Surgery

Alaraj

Amin‐Hanjani

Mostafa

et al. 2015

Stroke

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Background and Purpose— Wall shear stress (WSS) has been implicated as an important stimulus for vascular remodeling. The purpose of this study is to measure WSS in AVM arterial feeders using quantitative magnetic resonance angiography pre- and post-embolization/surgery. Methods— Records of patients who underwent AVM embolization and surgical resection at our institution between 2007 and 2013 and had WSS, flow rate, and vessel diameter obtained pre- and post-treatment using quantitative magnetic resonance angiography were retrospectively reviewed. WSS was compared between the feeder and contralateral artery pre- and post-embolization/surgery. Results— Twenty-one patients were included (mean age 34 years, 19% hemorrhagic presentation), with Spetzler–Martin grades 1 to 4. WSS, blood flow, and vessel diameter were assessed in a total of 51 feeder arteries. At baseline, mean WSS was significantly higher compared with the contralateral vessel (29.7±12.0 dynes/cm 2 versus 23.3±11.0 dynes/cm 2 ; P =0.007). After embolization (23.0 dynes/cm 2 versus 22.5 dynes/cm 2 ; P =0.78) and surgery (17.9 dynes/cm 2 versus 23.2 dynes/cm 2 ; P =0.09), WSS was not significantly different than in the contralateral vessel. Reduced WSS post-embolization corresponded to significantly decreased flow (338.1 mL/min versus 170.3 mL/min; P <0.001) and smaller vessel diameter (3.7 mm versus 3.5 mm; P =0.01). Conclusions— Enlargement of cerebral AVM arterial feeders is insufficient to compensate for increased blood flow, creating high WSS. After treatment, flow diminishes and so WSS and vessel diameter concomitantly decrease. Thus, WSS plays a pivotal role in vascular remodeling that may be exploited to monitor AVM response to treatment or understand other high-flow vascular pathologies.

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Section: Discussioncontrasting

confidence: 49%

Changes in Wall Shear Stress of Cerebral Arteriovenous Malformation Feeder Arteries After Embolization and Surgery

Alaraj

Amin‐Hanjani

Mostafa

et al. 2015

Stroke

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“…5,[8][9][10][11][12] We found that mean flow dropped on average by 29% after a single embolization session and by 75% at the end of all embolization sessions. Interestingly, the drop in flow per session did not correspond to occlusion of an intranidal fistula or the number of pedicles embolized in that single session, suggesting redistribution of flow through remaining compartments of the nidus in the setting of partial embolization, as posited by Kaspera et al 14 On the other hand, mean flow after completion of all embolization sessions correlated with both the total number of pedicles embolized and embolization of a high-flow fistula, with total pedicles embolized remaining predictive in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 60%

“…This QMRA technique has been validated using in vitro and in vivo models and has demonstrated utility in the hemodynamic evaluation of cerebrovascular pathologies and interventions, including extracranial carotid artery stenosis, intracranial angioplasty/stenting, carotid endarterectomy, and extracranial-intracranial bypass. [8][9][10][11][12] Total AVM blood flow was derived based on the aggregate flow within the primary arterial feeders relative to flow in their contralateral counterparts, according to the following equation: …”

Section: Blood Flow Measurementsmentioning

confidence: 99%

“…The mean number of pedicles embolized per session was 3 (range 1-8) and the mean total number of pedicles embolized was 8 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 2). However, the total number of pedicles embolized (R 2 =0.64, P<0.001) and embolization of an intranidal fistula (R 2 =0.40, P=0.002) are each significantly associated with total decreased AVM flow after completion of all sessions of embolization.…”

Section: Predictors Of Decreased Avm Blood Flow After Embolizationmentioning

confidence: 99%

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Quantitative Assessment of Changes in Cerebral Arteriovenous Malformation Hemodynamics After Embolization

Alaraj

Amin‐Hanjani

Aletich

et al. 2015

Stroke

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All sessions of embolization were performed with the liquid embolic agent N-BCA (N-butyl cyanoacrylate; Codman Neurovascular, Inc, Background and Purpose-Embolization reduces flow in arteriovenous malformations (AVMs) before surgical resection, but achievement of this goal is determined subjectively from angiograms. Here, we quantify effects of embolization on AVM flow. Methods-Records of patients who underwent AVM embolization at our institution between 2007 and 2013 and had flow rates obtained pre-and postembolization using quantitative magnetic resonance angiography were retrospectively reviewed. Total flow was estimated as aggregate flow within primary arterial feeders or flow in single draining veins. Results-Twenty-one patients were included (mean age 35 years, 24% hemorrhagic presentation) with Spetzler-Martin grades 1 to 4. Fifty-four total embolization sessions were performed. The mean AVM flow was 403.4±262.4 mL/min at baseline, 285.3±246.4 mL/min after single session (29% drop, P<0.001), and 102.0±103.3 mL/min after all sessions of embolization (75% drop, P<0.001). Total number of pedicles embolized (P<0.001) and embolization of an intranidal fistula during any session (P=0.002) were significantly associated with total decreased flow postembolization. On multivariate analysis, total pedicles embolized was predictive of total flow drop (P<0.001). However, pedicles embolized per session did not correlate with flow drop related to that session (P=0.44). Conclusions-AVM flow changes after embolization can be measured using quantitative magnetic resonance angiography.The total number of pedicles embolized after multiple embolization sessions was predictive of final flow, indicating this parameter is the best angiographic marker of a hemodynamically successful intervention. The number of pedicles embolized per session, however, did not correlate with flow drop in that session, likely because of flow redistribution after partial embolization. (Stroke. 2015;46:942-947.

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“…Planning for pharmacological, surgical or endovascular treatment of these abnormalities of blood vessels could all benefit from insights derived from realistic models of the circulatory dynamics in the diseased arterial network. Preliminary work on the use of quantitative magnetic resonance angiography (MRA) to predict stroke appears promising (Amin-Hanjani et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Simulation of the human intracranial arterial tree

Grinberg

Anor

Cheever

et al. 2009

Phil. Trans. R. Soc. A.

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High-resolution unsteady three-dimensional flow simulations in large intracranial arterial networks of a healthy subject and a patient with hydrocephalus have been performed. The large size of the computational domains requires the use of thousands of computer processors and solution of the flow equations with approximately one billion degrees of freedom. We have developed and implemented a two-level domain decomposition method, and a new type of outflow boundary condition to control flow rates at tens of terminal vessels of the arterial network. In this paper, we demonstrate the flow patterns in the normal and abnormal intracranial arterial networks using patient-specific data.

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Use of Quantitative Magnetic Resonance Angiography to Stratify Stroke Risk in Symptomatic Vertebrobasilar Disease

Cited by 140 publications

References 28 publications

Changes in Wall Shear Stress of Cerebral Arteriovenous Malformation Feeder Arteries After Embolization and Surgery

Changes in Wall Shear Stress of Cerebral Arteriovenous Malformation Feeder Arteries After Embolization and Surgery

Quantitative Assessment of Changes in Cerebral Arteriovenous Malformation Hemodynamics After Embolization

Simulation of the human intracranial arterial tree

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