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(Stroke. 1995;26:2298-2301.)
© 1995 American Heart Association, Inc.

Articles

Transcranial Color-Coded Duplex Sonography in Cerebral Arteriovenous Malformations

Christof Klötzsch, MD; Hans Henkes, MD; Hans C. Nahser, MD; Dietmar Kühne, MD Peter Berlit, MD

From the Departments of Neurology (C.K., P.B.) and Neuroradiology (H.H., H.C.N., D.K.), Alfried-Krupp-Hospital, Essen, Germany.

Correspondence to Christof Klötzsch, Department of Neurology, Alfried-Krupp-Hospital, 45117 Essen, Germany.

Background and Purpose It is well known that significant changes in cerebral hemodynamics may occur during the treatment of cerebral arteriovenous malformations with the complication of intracerebral hemorrhage and parenchymal edema. We used transcranial color-coded duplex sonography to study alterations in blood flow velocities during staged embolization.

Methods Forty-one patients aged 40±13 years (mean±SD) with angiographically proven cerebral arteriovenous malformations were studied. The blood flow velocities of the anterior, middle, and posterior cerebral arteries were measured in 16 patients with supratentorial arteriovenous malformations, both before the first and then after each successive embolization (three to seven treatments).

Results In 29 of 41 patients (71%), transcranial color-coded duplex sonography satisfactorily revealed the malformations and their main feeders. After the final embolization, we found a reduction in the peak flow velocity in treated feeders of 23±28% compared with the values before the first embolization. The untreated feeders showed an increase in peak flow velocities of 12±23% as an expression of increased collateral flow. After the treatment of the supplying feeders, we observed a reduction in flow velocity of 25±13% in seven patients, with cross-filling of the arteriovenous malformation through the contralateral anterior cerebral artery and the anterior communicating artery.

Conclusions The technical advantage of transcranial color-coded duplex sonography compared with transcranial Doppler sonography is that it allows the exact identification of different feeding arteries in arteriovenous malformations. Repeated measurements during stepwise embolization with corrected insonation angle are easily achieved, and noninvasive quantification of hemodynamic changes is possible. The method may be helpful in the planning of the different steps of embolization.

Key Words: cerebral arteriovenous malformation • duplex scanning • embolization, therapeutic • ultrasonics

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