Transvenous hemodynamic assessment of experimental arteriovenous malformations. Doppler guidewire monitoring of embolotherapy in a swine model.
Transvenous hemodynamic assessment of experimental arteriovenous malformations. Doppler guidewire monitoring of embolotherapy in a swine model.
复制标题
实验性动静脉畸形的经静脉血流动力学评估。
DOI：
10.1161/01.str.27.8.1365
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发表时间：
1996
期刊：
影响因子：
8.3
通讯作者：
Viñuela,F
中科院分区：
文献类型：
--
作者：
Murayama,Y;Massoud,TF;Viñuela,F
背景与目的应用多普勒导丝监测猪动静脉畸形（AVM）模型实验栓塞治疗期间引流静脉血流参数的进行性变化。方法将sa微导管超选择性放置于10只AVM猪的主动脉喂食器和主引流静脉内。应用多普勒导丝记录栓塞前动脉和静脉平均峰值流速（apv）和脉搏指数。在经动脉颗粒栓塞（8头猪）或液体粘接剂栓塞（2头猪）期间，将该装置留在引流静脉中，监测治疗期间和治疗后的连续经静脉流量。栓塞期多普勒血流参数与病灶血管造影变化定性相关。结果再栓塞引流静脉血流呈脉动性，平均APV为38.9±13.7 cm/s。栓塞后，这种情况明显改变为搏动减少或无搏动模式，平均APV降低为9.2±4.9 cm/s （P= 0.0001）。一个新的表达式，最大减去最小峰速度（MxPV - MnPV），用于评估经静脉多普勒频谱。栓塞后，平均流速从11.1±3.5 cm/s降至6.7±2.5 cm/s （P= 0.0025）。目的栓塞前后引流静脉血流动力学变化比病灶内主观血管造影变化更早被发现。结论经静脉多普勒导丝评估APV和MxPV - MnPV两个参数对实验性动静脉分流的血流动力学评价有重要意义，可用于血管内AVM栓塞治疗过程中的客观定量监测。
Background and PurposeA Doppler guidewire was used to monitor progressive changes in draining vein flow parameters during experimental embolotherapy in a swine arteriovenous malformation (AVM) model.MethodsA microcatheter was positioned superselectively in the main arterial feeder and main draining vein in each of 10 AVM models in swine. With use of the Doppler guidewire, preembolization arterial and venous average peak velocities (APVs) and pulsatility indices were recorded. The device was left in the draining vein during transarterial particulate (in 8 swine) or liquid adhesive (in 2 swine) embolization, and continuous transvenous flow during and after treatment was monitored. Periembolization Doppler flow parameters were correlated qualitatively with angiographic changes in the nidus.ResultsPreembolization draining vein flow was pulsatile, with a mean APV of 38.9±13.7 cm/s. After embolization, this changed significantly to a less pulsatile or nonpulsatile pattern, with a lower mean APV of 9.2±4.9 cm/s (P=.0001). A novel expression, the maximum minus the minimum peak velocity (MxPV−MnPV), was used in evaluating the transvenous Doppler spectra. This was reduced significantly after embolization from a mean of 11.1±3.5 cm/s to 6.7±2.5 cm/s (P=.0025). Objective periembolization hemodynamic changes were detected in the draining veins earlier than the visually subjective angiographic changes within the nidus.ConclusionsTransvenous Doppler guidewire assessment of two parameters, APV and MxPV−MnPV, is useful in the hemodynamic evaluation of experimental arteriovenous shunting and may be used for future objective and quantitative monitoring during endovascular AVM embolotherapy.