Research Laboratory of Cerebrovascular and Spinal Vascular Surgery

Andrey Petrov, MD, PhD
Leading Researcher, Chief of Neurosurgery Department

The Department of Cerebrovascular and Spinal Vascular Surgery was founded in 1972, and since its inception has been developing and advancing effective approaches to the study and treatment of various vascular neurosurgical disorders. Heads of the department were: S. A. Kesaev (from 1972 to 1986), Professor Yu.N. Zubkov (from 1986 to 1996), Professor V. S. Panuntsev (from 1997 to 2013), A. Yu. Ivanov (from 2014 to 2019).

Major research areas

• Studying the molecular biological mechanisms and genetic characteristics involved in the growth of arteriovenous malformations (AVM) in surgical treatment. Studying the factors associated with growth and progression of AVMs.
• Studying possible predictors for the recurrence of aneurysms after intravascular procedures.
• Developing the principles for combining endovasal and direct surgical approaches to increase the radicality of surgical treatment for patients with cerebrovascular conditions.
• Studying the pathophysiological features of venous outflow impairment in cerebrovascular conditions.
• Developing the optimal tactics and combined use of chemoembolization to treat hypervascular head and neck tumors.

Key achievements and results in 2016—2020

1. Advanced minimally invasive endovascular techniques for the treatment of cerebral AVMs using non-adhesive embolic agents of different viscosities, transvenous embolization and adenosine-induced cardiac arrest have been substantiated and introduced into clinical practice (Patent No. 2733684 issued on 06.10.2020, application No. 2019117251 dated 03.06.2020).
2. The molecular features of intrinsic angiogenesis factors (WEGF, ANG-2, PDGF, TGF, MMP) in cerebral arteriovenous malformations during surgical treatment are being studied, markers of complete AVM exclusion have been identified (Patent No. 2747661, registered on 11.05.2021, application No. 2020123114 dated 07.07.2020).
3. A new technology has been developed for distal embolization of the capsule of a chronic subdural hematoma with a non-adhesive embolic agent without subsequent surgical evacuation (Patent No. 2731254).
4. A personalized approach has been developed to treat hypervascular benign and malignant tumors of extra- and intracranial locations using embolization and chemoembolization (drug-eluting beads loaded with antiangiogenic agents).
5. Indications are being determined for the use of new generation HPC-coated flow diverter stents without the need for dual antiplatelet therapy.

Development prospects

• Personalized approach to treat hypervascular benign and malignant tumors of extra- and intracranial locations using chemoembolization with drug-eluting embolic beads loaded with antiangiogenic agents.
• Study of the molecular mechanisms associated with the growth and recurrence of cerebral arteriovenous malformations, identification of biomarkers of their complete exclusion and prediction of their evolution with surgical treatment, including advanced minimally invasive endovascular techniques using non-adhesive embolic agents of different viscosities, transvenous embolization and adenosine-induced cardiac arrest.
• A new concept for optimization of the surgical treatment strategy for complex, large and giant vertebrobasilar aneurysms based on the study of morphological and electrophysiological changes in the brain stem at the mesencephalo-ponto-bulbar level, MR tractography, electroneuromyography, assessment of cerebrospinal fluid dynamics at the level of the posterior cranial fossa and using the analytical program for mathematical assessment of blood flow in cerebral aneurysms (aneurysmalflow).
• Efficacy assessment and development of indications for the use of new generation HPC-coated flow diverter stents, studying the possibilities of using new antiplatelet agents (prasugrel) for implantation of flow diverter stents justifying the transition to single antiplatelet therapy.
• Innovative study of molecular, genetic and epigenetic mechanisms involved in the formation, growth and rupture of cerebral aneurysms as well as their recurrence after surgical exclusion. The study of miRNAs as clinically significant biological regulators of cellular and molecular processes associated with the initiation, growth and rupture of an aneurysm will allow distinguishing stable aneurysms with a low risk of rupture from aneurysms with a high risk of rupture and hemorrhage and will contribute to developing cost-effective screening tests for asymptomatic cerebral aneurysms.
• Detailed assessment of the functional reserve of cerebral blood flow autoregulation in patients with stenosing lesions of the precerebral arteries before and after reconstructive surgery of the brachiocephalic arteries, study of the effectiveness of cerebral revascularization in chronic ischemia using a combination of direct and indirect revascularization methods.
• Study of auxiliary endovascular therapy for malignant gliomas using direct transarterial superselective chemoembolization with biodegradable drug-eluting beads of glycolic and lactic acids allowing for reduced systemic toxicity and increased effectiveness of chemotherapy.

International collaboration (2018—2020)

• Diversion-p64 Post Market Clinical Follow-Up Study (2018—2019)
  Purpose: The use of P64 flow diverter stents to treat internal carotid artery aneurysms.
  According to the preliminary results of the trial, Almazov Centre became one of the 7 leading clinics among 26 participating European clinics. The results are scheduled for publication.

• Innovative Neurovascular Product Surveillance Registry (INSPIRE, MEDTRONIC) (2019—2022)
  Purpose: The use of PIPELINE FLEX flow diverter stents with Shield Technology.
  Shield Technology is designed to improve the hemocompatibility and deliverability of the implant by integrating synthetic phosphorylcholine to the surface of the braid. This technology allows implanting for acutely ruptured aneurysms.
  Almazov Centre ranks 2nd in the world for the number of procedures (54) performed as part of this project. The results are scheduled for publication.

• Participation in the international study in cooperation with the Clinic for Neuroradiology in Stuttgart (Prof. H. Henkes) and the 3rd City Hospital in Ulan Bator, Mongolia
  Purpose: The use of HPC-coated flow diverter stents to treat cerebral aneurysms without the need for dual antiplatelet therapy.