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.
Highlights
In clinical practices, the real-time flow of radiopaque agents revealed from digital subtraction angiography (DSA) images assists clinicians in determining the anatomical features of arteriovenous malformations (AVMs), which are a tangle of vessels connecting cerebral arteries and veins, bypassing the capillary bed (Spetzler et al, 1978; Quick et al, 2002; Flow Analysis for Arteriovenous MalformationFriedlander, 2007)
In the surgical planning process, cerebral hemodynamics pre- and post-arterial venous malformations (AVMs) resection is one of the core factors to be considered, and it is still not well understood (Rangel-Castilla et al, 2015). There are both favoring and contradicting clinical observations against the “normal pressure perfusion breakthrough” (NPPB) hypothesis proposed by Spetzler et al (1978) in 1978, which states that the tissues adjacent to AVM have a higher risk of hemorrhage after AVM resection, due to loss of regulation functions under chronic hypotension (Rangel-Castilla et al, 2015)
We used the information from DSA images of an AVM patient to alter an electrical analog model for cerebral circulation
Summary
The real-time flow of radiopaque agents revealed from digital subtraction angiography (DSA) images assists clinicians in determining the anatomical features of arteriovenous malformations (AVMs), which are a tangle of vessels (nidus) connecting cerebral arteries and veins, bypassing the capillary bed These anatomical features include the location, size, and the supplying and drainage patterns of an AVM (Rangel-Castilla et al, 2015; Ozpar et al, 2019). AVMs may rupture due to abnormal stress, but to which an extent would such a stress cause hemorrhage is still controversial (Gao et al, 1997; Rangel-Castilla et al, 2015)
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