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Case Reports
. 2018 Jul 13;13(4):917-920.
doi: 10.1016/j.radcr.2018.06.007. eCollection 2018 Aug.

Elevated end-diastolic ratio of the common carotid artery due to cerebral arteriovenous malformation: Two case reports

Koji Tanaka  1 , Shoji Matsumoto  2 , Takeshi Yamada  3 , Daisuke Kondo  2 , Hideo Chihara  4 , Motohisa Koga  5 , Taketo Hatano  4 , Tomoya Miyagi  5 , Ryo Yamasaki  1 , Jun-Ichi Kira  1
Affiliations
Case Reports

Elevated end-diastolic ratio of the common carotid artery due to cerebral arteriovenous malformation: Two case reports

Koji Tanaka et al. Radiol Case Rep. .

Abstract

An elevated end-diastolic (ED) ratio of the common carotid artery (CCA) is an indicator of occlusive lesions of the distal portion of the internal carotid artery. We report 2 cases of cerebral arteriovenous malformation (AVM) showing an elevated ED ratio of the CCA, which decreased after surgery. Case 1 was a 28-year-old man with chronic recurrent headache with aura, and case 2 was a 29-year-old woman with sudden-onset headache and intracerebral hemorrhage without neurologic abnormality. In both cases, digital subtraction angiography revealed a Spetzler-Martin Grade IV AVM, which was mainly fed by branches of the left middle cerebral artery with venous drainage into superficial and deep cerebral veins. Preoperative carotid ultrasonography showed an elevated CCA ED ratio (1.38 in case 1 and 1.47 in case 2; left > right) without atherosclerotic lesions. Patients' AVMs were successfully resected. In both cases, the ED ratio was decreased after surgery (to 1.05 in case 1 and 1.20 in case 2). A decrease in vascular resistance on 1 side caused by cerebral AVM can result in an increase in the CCA ED ratio comparable to that of carotid axis occlusion.

Keywords: Carotid ultrasonography; Cerebral arteriovenous malformation; End-diastolic ratio.

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Figures

Fig 1
Fig. 1
Case 1. (a) Preoperative left internal carotid arteriography (ICAG). Frontal (left) and lateral (right) projections show the arteriovenous malformation (AVM) and draining veins. (b) Preoperative carotid ultrasonography shows an increased end-diastolic flow velocity (EDV) in the left common carotid artery (CCA). PSV, peak systolic flow velocity; RI, resistance index. (c) Postoperative left ICAG. Frontal (left) and lateral (right) projections show that the AVM almost completely disappeared. (d) The elevated EDV in the left CCA is no longer evident in postoperative carotid ultrasonography.
Fig 2
Fig. 2
Case 2. (a) Preoperative left ICAG. Frontal (left) and lateral (right) projections show the AVM and draining veins. (b) Preoperative carotid ultrasonography shows an increased EDV in the left CCA. (c) Postoperative left ICAG. Frontal (left) and lateral (right) projections show the disappearance of most parts of the AVM. (d) The elevated EDV in the left CCA is no longer evident in postoperative carotid ultrasonography.
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References

    1. The Joint Committee of The Japan Academy of Neurosonology and The Japan Society of Embolus Detection and Treatment on Guideline for Neurosonology Carotid ultrasound examination. Neurosonology. 2006;19:49–69. [in Japanese]
    1. Goda T, Kobayashi J, Ohara N, Ikegami T, Watanabe K, Takahashi D. Usefulness of end-diastolic ratio in carotid ultrasonography for the screening of dural arteriovenous fistula: a case series. J Med Ultrason (2001) 2018;45:155–159. - PubMed
    1. Hisaeda E, Shimada H, Ogata T, Higashi T, Yamashita T, Matsunaga A. Evaluation before and after treatment of dural arteriovenous fistulas by carotid ultrasonography. Neurosonology. 2017;30:129–132. [in Japanese]
    1. Diener HC, Voigt K, Dichgans J. Diagnosis of intracranial malformations by Doppler sonography. Neurochirurgia. 1981;24:185–191. - PubMed
    1. Ogilvy CS, Stieg PE, Awad I, Brown RD, Jr, Kondziolka D, Rosenwasser R. Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Circulation. 2001;103:2644–2657. - PubMed

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