Giannis Sokratous, Tamara Tajsic, Yuhan Guo, Daniel Brown, Mathew R Guilfoyle, Adel Helmy, Rikin A Trivedi
Eleven patients with seventeen aneurysms were eligible for inclusion, of which fourteen conservatively managed flow aneurysms were analyzed. Eight patients harboring eleven flow aneurysms underwent surgical resection, with the remaining three patients receiving radiosurgery. After excluding completely regressed aneurysms, proximal feeding artery remodeling showed moderate-to-strong correlation to aneurysm regression (ρ = 0.68, P = .021), while distal feeding artery remodeling was unrelated (ρ = 0.00, P = 1.0). Distal type IIb flow related aneurysms were more likely to regress.
INTRODUCTION: Flow aneurysms associated with arteriovenous malformations may increase risk of hemorrhagic presentation and unfavorable outcome but their natural history and management, following treatment of the associated malformation remain uncertain.
RESEARCH QUESTION: To evaluate the relationship between changes in feeding vessel caliber and flow related aneurysm size, following complete surgical resection or stereotactic radiosurgery obliteration of the arteriovenous malformation.
MATERIAL AND METHODS: A retrospective observational study was performed (2008-2017), including all patients with symptomatic arteriovenous malformation, at least one flow related, conservatively managed aneurysm and angiographically complete resection or obliteration of the malformation following treatment. Aneurysm, proximal and distal feeding artery dimensions were obtained before and after treatment. Spearman rank coefficients and linear regression analysis were used to describe any correlation, its strength and direction.
RESULTS: Eleven patients with seventeen aneurysms were eligible for inclusion, of which fourteen conservatively managed flow aneurysms were analyzed. Eight patients harboring eleven flow aneurysms underwent surgical resection, with the remaining three patients receiving radiosurgery. After excluding completely regressed aneurysms, proximal feeding artery remodeling showed moderate-to-strong correlation to aneurysm regression (ρ = 0.68, P = .021), while distal feeding artery remodeling was unrelated (ρ = 0.00, P = 1.0). Distal type IIb flow related aneurysms were more likely to regress.
DISCUSSION AND CONCLUSIONS: Changes in proximal feeding artery diameter may help predict fate of flow aneurysms. Our findings support incorporating proximal feeding artery remodeling into post-treatment radiological assessment. With further validation, it may represent a biomarker for treatment efficacy in patients with flow aneurysms, and help inform personalized treatment strategies.