栓塞对脑动静脉畸形血液动力学的影响

The hemodynamic effects after embolization of cerebral arteriovenousmalformations

栓塞虽可使脑 AVM 体积缩小,但对其血液动力学影响仍不明确。本文报告30例脑 AVM栓塞治疗前后经颅多普乐(TCD)测得的供血动脉流速改变。单支动脉供血的 AVM 完全栓塞后流速下降50%以上并低于正常值。多支动脉供血者部分栓塞后,早期见被栓塞的供血动脉流速降低,而未被栓塞者流速只有轻度下降或无改变;晚期见被栓塞的供血动脉流速可进一步下降抑或回升,提示 AVM内部血栓形成或再通,而未被栓塞者流速普遍增高。作者认为应争取对每一支供血动脉均行栓塞治疗,对栓塞后残余的 AVM 应采取积极态度,后续的手术时机以两周内为佳。

Although embolization has been provedfavourable for reduction of the volume of arteriove-nous malformations(AVMs),but its hemodynamic ef-fects remain vague.This paper reports blood velocitychanges after embolization detected by transcranialcolour doppla(TCD)in 30 cases.Unisupplied AVMswere completely occluded and the immediate TCDshowed the velocity of feeding artery decreased over50% and were lower than normal values.In the earlystages after partial embolization for multisuppliedAVMs,the velocity of treated feeding arteries de-creased while in untreated ones remain unchanged orslightly decreased.In late stages,the velocity oftreated feedin arteries progressively decreased or in-creased,suggesting thrombosis or recanalization insidethe nidus,and the velocity of untreated feeding arter-ies increased.The authors think that if possible,allthe feeders should be embolized and the residual partsof the AVMs should be treated actively.The besttiming of subsequent surgery is probably within 2weeds after embolization.