Hemodynamic hemorrhage prevention algorithm during cerebral arteriovenous malformations embolization

The hemodynamic mechanisms causing perirpocedural bleeding during embolization of cerebral arteriovenous malformations (AVMs) have been under consideration. The new definition of unit load has been introduced as quantity of energy produced when blood flows through the unit of AVM volume in the unit of time. Mathematical model shows dramatic increase of unit load when 60-70 % of AVM is embolized, which explains the phenomenon of rupture of subtotally obliterated AVMs. Quantitative and qualitative concordance of the model with clinical data was demonstrated. It was achieved by invasive measurement of blood pressure and flow velocity in feeding and draining vessels of AVM using ComboMap (Volcano, USA) device with subsequent plotting of the unit load in life patients. Algorithm with emphasis on angioarchitectonical peculiarities and new understanding of AVM hemodynamics has been proposed. Retrospective analysis of anonymous digital videos of endovascular procedures of 124 consecutive patients with Spetzler-Ponce A and B class AVMs was performed by two interventional neurororadiologists (referred to as 1 and 2). Two pairs of statistically homogenous groups were formed: the first one with patients who were treated in accordance with the algorithm (group a), and the second with those who were not (group b). Hemorrhage rate in group 1a was 5 of 99 (5.1 %) and in group 2a it was 4 of 102 patients (3.9 %), while in group 1b and 2b it consisted 10 of 25 (40 %) and 11 of 22 patients (50 %) respectively. There was no statistically significant difference between the opinions of specialists. In both pairs of groups the statistically significant decrease of hemorrhage rate was achieved by the introduction of algorithm (F1 = 4,08; p < 0,01, F2 = 4,994; p < 0,01).

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Krivoshapkin A.L. - doctor of medical sciences, professor, corresponding member of the RAMN, head of neurosurgical center, head of neurosurgical chair, e-mail:alkr01@yandex.ru
Panarin V.A. - neurosurgeon, e-mail: p0203@mail.ru
Orlov K.Yu. - candidate of medical sciences, senior researcher, head of neurosurgery department, head of endovascular neurosurgery research group, assistant professor, e-mail: orlov72@mail.ru
Berestov V.V. - junior researcher in the group of endovascular neurosurgery, e-mail: 3021@mail.ru
Shayakhmetov T.S. - junior researcher of the group of endovascular neurosurgery, e-mail: ts-shayakhmetov@yandex.ru
Gorbatykh A.V. - neurosurgeon, e-mail: antonosjn@mail.ru
Kislitsin D.S. - neurosurgeo, e-mail: kislitsinmd@gmail.com
Chupakhin A.P. - doctor of physical and mathematical sciences, head of the laboratory, professor, head of the chair
Cherevko A.A. - candidate of physical and mathematical sciences, researcher, assistant professor
Khe A.K. - candidate of physical and mathematical sciences, researcher, assistant professor
Sergeev G.S. - resident of the neurosurgery chair, e-mail: dr.gssergeev@gmail.com
Chebykin D.V. - candidate of medical sciences, assistant professor of the chair for public health and healthcare