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Reduce Stroke Risk in Arteriovenous Malformation (AVM) Resection

By Tim Callahan30 Nov 2022

When Della Puppa, et al performed flow measurements on 92 vessels during Arteriovenous Malformation (AVM) resection on 25 patients, they found that flow measurement “proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of AVM resection.”

Due to the challenging nature of AVM surgery, there is an increased risk of cerebrovascular accidents, requiring even higher precision from the surgeon. Transit time flow measurement (TTFM) can guide the procedure as well as confirm its success.

Knowing true volume blood flow during the procedure is key to reducing intraoperative pitfalls, such as the risk of massive bleeding. Flow measurement during AVM resection can also help the clinician understand the architecture of the AVM, which helps guide surgical planning in real time. By taking the guesswork out of blood flow assessment, the surgeon can significantly reduce the risk of intra and post-operative stroke.

Other measurement modalities in cerebrovascular surgery

There are several measurement modalities in use for cerebrovascular surgery in addition to transit time flow measurement. Here is a look at them and their disadvantages:

  • Intraoperative Angiography: Intraoperative angiography provides an anatomical image of a region of the circulatory system. It can be used for assessment of vessel patency and residual aneurysm. Disadvantages include invasiveness and time required for the procedure. It’s impractical and has a low effectiveness in averting ischemia.
  • Microvascular Doppler Sonography: Microvascular doppler sonography measures velocity, not volume flow. It can’t discern between mild and severe vessel occlusion and is unreliable in its effectiveness in averting ischemia.
  • Fluorescein Dye and Indocyanine Green (ICG) Video Angiography: Following intravenous administration of fluorescein dye, fluorescein angiography images vessels with light. The image quality can be problematic and the dye carries the potential for systemic adverse reaction.
  • Electrophysiological Monitoring: Electrophysiological monitoring is labor intensive and is prone to false negatives.
  • Pulse Detection: Observation of pulse is a subjective art form that cannot provide a reliable indicator of qualitative information about vessel occlusion.

Cerebrovascular flowprobes for use in AVM resection

Charbel Flowprobes can be used as a quantitative tool during the resection/obliteration of an AVM. The flowprobe directly measures blood volume flow in cerebral vessels to guide surgical strategies.

Quantitative flow measurements verify preservation or augmentation of flow and allow for immediate corrective action, if needed, before closing the patient.

The Charbel Cerebrovascular flowprobes are designed to reduce the risk of intraoperative and postoperative stroke, and reduce time in the operating room. They are also designed to provide easy access in tight spaces to enable intraoperative flow measurement and provide critical information.

Ready to learn more about how they can assist you in reducing stroke in AVM? Contact our specialists today.