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Modelling of the arteriovenous malformation embolization optimal scenario.

ABSTRACT: Cerebral arteriovenous malformation (AVM) is a congenital brain vessels pathology, in which the arterial and venous blood channels are connected by tangles of abnormal blood vessels. It is a dangerous disease that affects brain functioning causing the high risk of intracerebral haemorrhage. One of AVM treatment methods is embolization-the endovascular filling of the AVM vessel bundle with a special embolic agent. This method is widely used, but still in some cases is accompanied by intraoperative AVM vessels rupture. In this paper, the optimal scenario of AVM embolization is studied from the safety and effectiveness of the procedure point of view. The co-movement of blood and embolic agent in the AVM body is modelled on the basis of a one-dimensional two-phase filtration model. Optimal control problem with phase constraints arising from medicine is formulated and numerically solved. In numerical analysis, the monotone modification of the CABARET scheme is used. Optimal embolization model is constructed on the basis of real patients' clinical data collected during neurosurgical operations. For the special case of embolic agent, input admissible and optimal embolization scenarios were calculated.

SUBMITTER: Cherevko AA

PROVIDER: S-EPMC7428277 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Modelling of the arteriovenous malformation embolization optimal scenario.

Cherevko Alexandr A AA Gologush Tatiana S TS Petrenko Irina A IA Ostapenko Vladimir V VV Panarin Vyacheslav A VA

Royal Society open science 20200722 7

Cerebral arteriovenous malformation (AVM) is a congenital brain vessels pathology, in which the arterial and venous blood channels are connected by tangles of abnormal blood vessels. It is a dangerous disease that affects brain functioning causing the high risk of intracerebral haemorrhage. One of AVM treatment methods is embolization-the endovascular filling of the AVM vessel bundle with a special embolic agent. This method is widely used, but still in some cases is accompanied by intraoperativ ...[more]

PMID: 32874606

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Project description:BackgroundThe hemodynamics of cerebral arteriovenous malformation (cAVM) is difficult to evaluate with conventional imaging or clinical grading. The aim of this study is to: (I) investigate the association between the angioarchitecture and hemodynamic parameters in cAVM based on 4-dimentional flow magnetic resonance (4D flow MR); (II) quantify flow changes during follow-up after embolization and explore the potential of flow-guided staged embolization.MethodsTwenty-one patients with digital subtraction angiography (DSA)-diagnosed cAVM were prospectively enrolled in a tertiary hospital consecutively from April 2022 to January 2024 for a cohort study. Lesion angioarchitecture at baseline was assessed by DSA. 4D flow MR was performed to assess hemodynamics. Flow-derived parameters included velocity, flow, time averaged wall shear stress (WSS) of the main feeding artery, and inflow-to-outflow ratio. Hemodynamic metrics were compared between groups with different angioarchitecture and rupture status. Seven patients had a post embolization follow-up 4D flow MR scan with a median interval of 8.9 months.ResultsAmong multiple angioarchitectural features, supply by a single feeding artery (6/7 in the ruptured group and 0/14 in the unruptured group, P<0.001) and intra nidal aneurysm (7/7 in the ruptured group and 5/14 in the unruptured group, P=0.007) were significantly associated with lesion rupture. The ruptured cAVM showed lower total flow of feeding arteries (2.09±3.15 vs. 6.05±3.76 mL/s, P=0.029), lower WSS (0.99±0.73 vs. 2.10±0.45 Pa, P=0.023) and higher inflow-to-outflow ratio (2.46±0.79 vs. 1.46±0.55, P=0.041). During follow-up, the total flow of the lesions decreased by 10-100% after the embolization. The nidus volume decreased significantly (reduction rate: 59.6-100%, P=0.009). The flow of the minor feeding artery increased in 2 cases out of 5, indicating flow remodeling. Three patients had a second embolization guided by the follow-up imaging.ConclusionscAVM lesions tend to have heterogeneous hemodynamics even with similar angioarchitecture. This could be captured and quantified on an individual basis using 4D flow MR. Flow analysis by MR offers the potential to guide a second embolization.

Project description:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting. This is an update of a previously published review. OBJECTIVES:To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices. SEARCH METHODS:We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 10 April 2017.We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 27 August 2017). to be updatedWe checked cross-references and searched references from review articles. SELECTION CRITERIA:Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device. DATA COLLECTION AND ANALYSIS:Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed. MAIN RESULTS:There were no randomised controlled trials included in the review; one ongoing trial has been identified which may be eligible for inclusion in the future. AUTHORS' CONCLUSIONS:There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation is a safe procedure which reduces morbidity and mortality. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials.

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Modelling of the arteriovenous malformation embolization optimal scenario.

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Modelling of the arteriovenous malformation embolization optimal scenario.

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