Pulmonary AVM Cohort Study

• Research type

  Research Study

• Full title

  Deep phenotyping of pulmonary arteriovenous malformation patients pre and post embolziation for stroke prevention

• IRAS ID

  132758

• Contact name

  Claire Shovlin

• Contact email

  c.shovlin@imperial.ac.uk

• Sponsor organisation

  Imperial College London

• Research summary

  Strokes are the third most common cause of death and cause major disability. Ischaemic stroke, the most common form, occurs when a region of the brain is deprived of oxygenated blood supply, usually due to direct occlusion of arterial vessels. Asymptomatic disease is very common, and recent data suggest it accounts for a surprisingly high portion of dementia.
  
  We hypothesised that better characterisation of a population at high risk of ischemic strokes and cerebral ischaemia will enable better characterisation of stroke risks, and ultimately lead to new methods of stroke/dementia prevention.

  Patients with pulmonary arteriovenous malformations (PAVMs) are at high risk of ischemic strokes because they have a compromised pulmonary capillary filter. Normally, the pulmonary capillary bed provides a first-pass filtration system for particulate matter forming or entering the venous circulation in the preceding cardiac cycle. Data from US groups indicate that more than 50% of patients have evidence of formal infarcts on conventional cerebral MR scans. Over the last 14 years, we have characterised a unique population drawn from referrals across the UK, focusing on clinical strokes which we have shown can be prevented by embolization treatment (see patient website at http://www1.imperial.ac.uk/nhli/cardio/vascular/pulmonary_vascula r/hhtsurvey/hht_pavms/).
  The goals of this current study are to:
  •To determine the optimal MR assessment methods for cerebral ischemia/infarction in the PAVM population;
  • To characterise the evolving nature of ischemic stroke burden in PAVM patients using specialised MRI scans before and after planned treatment by embolization, accompanied by neuropsychometric testing
  • To use serial blood and urine samples at the same timepoints to measure potential new biomarkers for stroke risk;
  • To correlate MRI, neuropsychometric, and blood/urine findings, aiming to identify novel stroke biomarkers.

  While the findings will be primarily relevant to the PAVM patients, findings may also be relevant to general stroke pathogenesis.

• REC name

  East Midlands - Leicester South Research Ethics Committee

• REC reference

  13/EM/0246

• Date of REC Opinion

  16 Sep 2013

• REC opinion

  Further Information Favourable Opinion