MMP9 as a likely predictor of de novo aneurysm formation in a group of cerebral arteriovenous malformations with AVM-associated aneurysms

SUMMARY. Timely and complete diagnosis of AVM-associated aneurysms is essential to prevent the risk of intracranial haemorrhage. AVM-associated aneurysms are found in 12–46 % of patients with AVMs, which is many times the incidence of cerebral aneurysms in the population. When an AVM is combined with an aneurysm, the risk of haemorrhage is 9.8 % per year, increasing the risk of recurrent intracranial haemorrhage to 53.6 %, whereas when there is no such combination, haemorrhage occurs in only 1.7 % of patients with an AVM per year. Currently, there is no consensus on the management tactics for patients with AVM-associated aneurysms. Л.В. Рожченко с соавт. Том XV, №2, 2023 РОССИЙСКИЙ НЕЙРОХИРУРГИЧЕСКИЙ ЖУРНАЛ имени профессора А.Л. Поленова 89 MATERIALS AND METHODS. The study included 287 patients with cerebral AVMs who received surgical treatment in the Department of Brain Vascular Surgery at the A.L. Polenov Russian Research Institute for Cardiovascular Surgery from 2010 to 2020. We assessed AVM-associated aneurysms shutdown against the background of multistage endovascular treatment as well as the occurrence of AVM-associated aneurysms de novo. Serum levels of matrix metalloproteinase‑9 (MMP‑9) were determined before and 24 hours after each stage of endovascular embolization using an enzyme immunoassay (Personal Lab, Adaltis, Italy) at each stage of endovascular treatment. Sixty-eight (23.7 %) of 287 patients were found to have preoperatively associated AVM aneurysms (Group 1). Intracranial hemorrhage occurred in 56 (82.3 %) of 68 patients. 219 patients with AVMs without aneurysms (Group 2) showed hemorrhagic course in 116 (52.9 %) cases. CONCLUSIONS. It was found that 29 % of partially embolized AVM-associated aneurysms with high baseline MMP9 levels form de novo aneurysms, and increasing MMP9 levels over time is a predictor of this risk. The pathogenesis of AVMassociated aneurysms in AVMs is unclear. High baseline MMP9 levels increasing with multistage embolisation may be an easily identifiable predictor of the risk of de novo AVM-associated aneurysms in AVMs identified prior to treatment. 

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