Analysis Of Risk Factors Of Brain Arteriovenous Malformation Hemorrhage And Its Relationship With Endothelial Progenitor Cells

Part Ⅰ Analysis of Risk Factors of Brain Arteriovenous Malformation HemorrhageOBJECTIVE:To analysis whether specific clinical and vascular factors have relevance to the hemorrhage of cerebral arteriovenous malformations (AVM) and to predict and evaluate the risk of hemorrhage for individual AVM patients.METHODS:By the method of retrospectively analyzing, we reviewed the clinical histories of164operation-confirmed AVM patients who admitted to Huashan Hospital Affiliated to Fudan University from Jan,2004to Dec,2010. Clinical and vascular parameters were evaluated by univariate analysis and multivariate logistic regression analysis to assess factors associated with hemorrhagic presentation.RESULTS:By univariate analysis, deep-seated AVMs, small AVMs, a single draining vein were associated with hemorrhagic presentation. There was no statistically significant relationship between gender, age, type of arterial feeders and AVM hemorrhage. When multivariate logistic regression analysis was applied, only deep-seated AVM and a single draining vein were associated with presentation of hemorrhage. Small size did not independently correlate with hemorrhagic presentation.CONDLUSION:The probability of hemorrhagic presentation in patients with cerebral AVMs is associated with multiple risk factors. Deep-seated location and a single draining vein are the independent risk factors. Part Ⅱ Evidence of Endothelial Progenitor Cells in the Human Brain Arteriovenous MalformationsOBJECTIVE:To investigate whether there are increased EPCs levels in the brain AVM nidus..METHODS:Surgical specimens without endovascular embolization and radiosurgery from the brain AVMs (n=42) were examined. Cerebral cortex obtained from epilepsy surgery were chosen for control comparisons. EPCs were identified as cells that were double-positive for the stem cell marker CD34and the endothelial cell marker VEGFR-2(KDR). In addition, SDF-1was also characterized.RESULTS:Brain AVM tissues displayed more CD34, KDR positive signals than epilepsy control tissues. The level of EPCs was increased in the BAMV nidus, mainly at the edge of the vessel wall. The expression of SDF-1was colocalized with CD31-positive and α-smooth muscle cells.CONDLUSION:EPCs are present in the nidus of the BAVMs, which may mediate pathological vascular remodeling and impact the clinical course of AVMs. Part Ⅲ Levels of Endothelial Progenitor Cells in the Human Brain Arteriovenous Malformations of Different Ages and SymptomsOBJECTIVE:The aim of this study is to investigate the relationship between EPC levels and age, bleeding rate in BAVM patients.METHODS:Forty-two surgical specimens from BAVMs were divided according to the age or symptom. According to the age, the patients were divided into3groups:under20years, aged20to50years and over50years. According to the symptom, the patients were divided into2groups:ruptured BAVMs and unruptured BAVMs. EPCs were identified as cells that were double-positive for the endothelial cell marker VEGFR-2(KDR) and stem cell marker CD34.RESULTS:The number of EPCs was increased in young group (group1and2) compared to the other4groups (p<0.05). The number of EPCs was no difference between ruptured and unruptured patients in each age group.CONDLUSION:We demonstrated that EPCs were increased in the BAVM patients, especially in teen-age patients, suggesting EPCs plays important role in the process of vascular remodeling. The number of EPCs was similar in both rupture and unruptured BAVMs, suggesting the effect of EPCs in ruptured BAVMs was limited.