Comparison of 3d rotational angiography with digital subtraction angiography and correlation of angioarchitecture with clinical presentations in cerebral arteriovenous malformations
No Thumbnail Available
Files
Date
2019-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
SCTIMST
Abstract
Brain arteriovenous malformations (AVM) are an intriguing
disease entity involving the intracranial vasculature where arteries and
veins are interconnected through a low resistance dysplastic nidus
bypassing the normal intervening capillary network.[1]
There are several morphological aspects of AVM that need to be
assessed prior to planning therapeutic approach and intervention. These
include location, feeding arteries, draining veins, nidus and size of the
lesion.[2] The presence of feeding artery, intranidal and perinidal
aneurysms, venous pouches, venous dilatations, fistulas, venous stenosis
and venous thrombosis are the other factors which necessitate therapy in
brain arteriovenous malformations.[3,4] An ideal imaging modality
should reliably reveal these parameters. Digital subtraction angiography
(DSA) very reliably predicts the presence of these varied parameters.
DSA is the standard imaging procedure for AVM. However, although it
gives a good impression of the spatial relationships between the vessels, it
is limited by overprojection of early draining veins on arterial feeders and
nidus and cannot give a true three-dimensional (3D) view from every
angle. The 3D rotational angiographic (RA) images have excellent
resolution, and can be rotated in any direction to show the structures from
any required angle, including views that would be impossible to obtain by
radiographic projections alone. An improved understanding of the 3D
vascular morphology helps to ensure optimum positioning of the image
intensifier during the intervention for guideline positioning of catheters,
coils, balloons and stents.[5] There are few studies comparing the utility
of 3D RA in cerebral aneurysm.[6,7] Hochmuth A et al., in their study
have concluded that compared with DSA, 3D RA allows more exact 2
depiction of anatomic details that are important in planning surgery and
interventional therapy for intracranial aneurysms and also RA depicted
more aneurysms.[8] The current gold standard in imaging of brain AVM
is superselective microcatheter angiography. We intended to study the
effect of addition of 3D RA in better delineation of angioarchitecture of
the lesions.
Cerebral AVM has varied clinical presentations. Broadly it can
present because of haemorrhage and unbled lesions can manifest with
seizure, headache, neurodeficit or vague neurologic symptoms. Also
asymptomatic lesions are detected incidentally due to neuroimaging for
inexplicit symptoms. Various angiographic features like deep venous
drainage, deep location, infratentorial location, distal flow related &
intranidal aneurysm, previous haemorrhage has been implicated as risk
factors or predictors of haemorrhagic complications.[9] Few studies have
attributed manifestation of seizure in AVM to angiographic features like
cortical location of feeder, feeder by MCA, absence of aneurysm,
varix/varices in venous drainage.[10] Other clinical manifestations like
headache and neurodeficit in unbled AVM has not been studied in
relation to specific angiomorphologic attribute. Combining the 2D DSA
& 3D RA is expected to generate the best possible angiomorphology of
AVM. We intend to analyse the angiographic predictors for clinical
manifestations of haemorrhage, seizure, headache & neurodeficit; thereby
prompting necessary therapeutic intervention.