This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fleischer, L. H. Articles by Mohr, J. P. Search for Related Content PubMed PubMed Citation Articles by Fleischer, L. H. Articles by Mohr, J. P.

Stroke, Vol 24, 1897-1902, Copyright © 1993 by American Heart Association

ARTICLES

Relationship of transcranial Doppler flow velocities and arteriovenous malformation feeding artery pressures

LH Fleischer, WL Young, J Pile-Spellman, B terPenning, A Kader, BM Stein and JP Mohr
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032.

BACKGROUND AND PURPOSE: Feeding mean arterial pressure immediately proximal to the nidus of arteriovenous malformations may influence the frequency of spontaneous intracerebral hemorrhage. This study assessed the usefulness of transcranial Doppler ultrasound velocities as a noninvasive estimate of feeding mean arterial pressure. METHODS: We studied 41 patients undergoing 73 staged treatments of arteriovenous malformations with endovascular embolization, surgery, or both. Before treatment during the awake state, transcranial Doppler mean and peak velocities were recorded in proximal Willisian vessels. During superselective angiography with the patient under conscious sedation or during surgery with the patient under general anesthesia, feeding mean arterial pressure was measured through a 1.5F transfemoral intracranial microcatheter or a 26-g needle by direct puncture. Measurement of insonated artery diameter was possible in 41 embolizations, and a flow velocity index (mL/min) and Reynolds' number were estimated. RESULTS: Mean +/- SEM feeding mean arterial pressure was 38 +/- 2 mm Hg at a systemic mean arterial pressure of 77 +/- 2 mm Hg; mean velocity was 102 +/- 4 cm/s. There was an inverse correlation between feeding mean arterial pressure and parent artery mean velocity (y = -0.74x + 130, r = .35, P = .0025). The best correlation was for the first treatment in each patient (n = 27) using the highest peak velocity obtainable in a Willisian vessel ipsilateral to the arteriovenous malformation (y = - 1.61x + 221, r = .62, P = .0005). Flow velocity index (775 +/- 106 mL/min) did not correlate with feeding mean arterial pressure, but there was a weak correlation with Reynolds' number (y = -12x + 1616, r = .27, P = .1283). Mean Reynolds' number was 1257 +/- 119. CONCLUSIONS: Transcranial Doppler mean velocity is correlated with feeding mean arterial pressure but only weakly predictive. Considerations influencing the relation of distal feeding mean arterial pressure to proximal mean velocity might include the influence of other fistulae in the circuit between major inflow and outflow channels as well as turbulent flow at vascular branch points between point of insonation and the nidus, as suggested by Reynolds' number values of more than 400.

This article has been cited by other articles:

				D. H. Duong, W. L. Young, M. C. Vang, R. R. Sciacca, H. Mast, H.-C. Koennecke, A. Hartmann, S. Joshi, J. P. Mohr, and J. Pile-Spellman Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations Stroke, June 1, 1998; 29(6): 1167 - 1176. [Abstract] [Full Text] [PDF]

				Y. Murayama, S. Usami, Y. Hata, F. Ganaha, Y. Hasegawa, T. Terao, S. Abe, H. Furuhata, and T. Abe Transvenous Hemodynamic Assessment of Arteriovenous Malformations and Fistulas: Preliminary Clinical Experience in Doppler Guidewire Monitoring of Embolotherapy Stroke, August 1, 1996; 27(8): 1358 - 1364. [Abstract] [Full Text]

				Y. Murayama, T. F. Massoud, and F. Vinuela Transvenous Hemodynamic Assessment of Experimental Arteriovenous Malformations: Doppler Guidewire Monitoring of Embolotherapy in a Swine Model Stroke, August 1, 1996; 27(8): 1365 - 1372. [Abstract] [Full Text]

				C. Klotzsch, H. Henkes, H. C. Nahser, D. Kuhne, and P. Berlit Transcranial Color-Coded Duplex Sonography in Cerebral Arteriovenous Malformations Stroke, December 1, 1995; 26(12): 2298 - 2301. [Abstract] [Full Text]

				H. Mast, J. P. Mohr, A. Osipov, J. Pile-Spellman, R. S. Marshall, R. M. Lazar, B. M. Stein, and W. L. Young `Steal' Is an Unestablished Mechanism for the Clinical Presentation of Cerebral Arteriovenous Malformations Stroke, July 1, 1995; 26(7): 1215 - 1220. [Abstract] [Full Text]