Molecular mechanisms of growth and recurrence of cerebral arteriovenous malformations: part 2 (our own research)

Abstract

Cerebral arteriovenous malformations (AVM) are not static congenital formations. These structures can grow, recur, and even appear de novo after a "complete" cure. To analyze the dynamics of angiogenic factors before and after embolization of cerebral AVMs. The study enrolled 314 patients with AVM who underwent endovascular treatment at the Department of Brain Vessels Surgery of the Polenov Russian Research Neurosurgical Institute for the period from 2011 to 2017. The control group included 33 healthy volunteers. Their age was comparable to that in the main group. The levels of serum vascular endothelial growth factor (VEGF), angiopoietin-2 (ANG-2) and matrix metalloproteinase-9 (MMP-9) were measured before and in 24 hours after endovascular embolization using enzyme-linked immunosorbent assay (Personal Lab, «Adaltis», Italy). Increased levels of VEGF, MMP-9 and ANG-2 were observed in 48.4% of primary patients with AVM. No correlation of increased level of these factors with gender, age, co-morbidities, localization and structure of AVM was found. High level of VEGF and MMP-9 was typical for AVM Spetzler-Martin grade III, AVM with hemorrhagic course, drainage into the deep cerebral veins and with afferents from the external carotid artery. Total embolization of AVM led to normalization of all elevated angiogenesis factors. In contrast, partial embolization resulted augmentation of VEGF and MMP-9 levels. Normalization of all elevated growth factors after total embolization confirms the absence of potency for AVM recurrence. Identification of the factors predisposing to possible growth of AVM should be a justification for total resection of AVM. Persistent elevation of serum growth factors after total embolization in accordance with the angiographic criteria may be a sign of subtotal occlusion of AVM.