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Updated: Jun 16, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Systemic expression of matrix metalloproteinase-9 in patients with cerebral arteriovenous malformations
Robert M Starke1, Ricardo J Komotar, Brian Y Hwang
1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Objective:
Increased expression angiogenic factors, such as matrix metalloproteinases (MMPs), are associated with the formation of cerebral arteriovenous malformations (AVMs). The objective of this study was to determine plasma levels of MMP-9 of patients with AVMs.
Methods:
Blood samples were drawn from 15 patients with AVMs before treatment, 24 hours postembolization, 24 hours postresection, and 30 days postresection. Blood samples were also obtained from 30 healthy controls. Plasma MMP-9 concentrations were measured via enzyme-linked immunosorbent assay.
Results:
The mean plasma MMP-9 level in AVM patients at baseline was significantly higher than in control patients: 108.04 +/- 16.11 versus 41.44 +/- 2.44 ng/mL, respectively. The mean plasma MMP-9 level 1 day after embolization increased to 172.35 +/- 53.76 ng/mL, which was not significantly elevated over pretreatment levels. One day after resection, plasma MMP-9 levels increased significantly over pretreatment levels to 230.97 +/- 51.00 ng/mL. Mean plasma MMP-9 concentrations 30 days after resection decreased to 92.8 +/- 18.7 ng/mL, which was not different from pretreatment levels but was still significantly elevated over control levels. MMP-9 levels did not correlate with patient sex, age, presentation, or AVM size.
Conclusion:
Plasma MMP-9 levels are significantly elevated over controls at baseline, increase significantly immediately after surgery, and decrease to pretreatment levels during follow-up.
Insights
Plasma matrix metalloproteinase-9 (MMP-9) levels are elevated in patients with cerebral arteriovenous malformations (AVMs). Levels increase after surgery but return to baseline, remaining higher than controls.
Area of Science:
- Biochemistry
- Vascular Biology
- Neurosurgery
Background:
- Cerebral arteriovenous malformations (AVMs) are linked to increased expression of angiogenic factors like matrix metalloproteinases (MMPs).
- Matrix metalloproteinase-9 (MMP-9) plays a role in vascular remodeling and angiogenesis.
Purpose of the Study:
- To investigate plasma concentrations of MMP-9 in patients diagnosed with cerebral AVMs.
- To assess changes in MMP-9 levels following embolization and surgical resection of AVMs.
Main Methods:
- Plasma samples were collected from 15 AVM patients at multiple time points: pre-treatment, 24 hours post-embolization, 24 hours post-resection, and 30 days post-resection.
- Blood samples from 30 healthy individuals served as controls.
- Plasma MMP-9 concentrations were quantified using enzyme-linked immunosorbent assay (ELISA).
Main Results:
- Baseline plasma MMP-9 levels were significantly higher in AVM patients (108.04 ± 16.11 ng/mL) compared to controls (41.44 ± 2.44 ng/mL).
- MMP-9 levels increased significantly after resection (230.97 ± 51.00 ng/mL) but showed a non-significant rise post-embolization.
- By 30 days post-resection, MMP-9 levels decreased to baseline but remained elevated compared to controls.
Conclusions:
- Plasma MMP-9 is significantly elevated in AVM patients compared to healthy individuals.
- MMP-9 levels acutely increase following AVM surgery.
- While MMP-9 levels decrease during follow-up, they remain elevated above control levels, suggesting ongoing vascular changes.
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