Evaluation before and after treatment of dural arteriovenous fistulas by carotid ultrasonography

Dural arteriovenous fistula was examined by carotid ultrasonography (CUS) in five patients with cavernous sinus dural arteriovenous fistula (CS-dAVF) and 14 patients with transverse sigmoid sinus dural arteriovenous fistula (TS-dAVF). All 19 patients were diagnosed using digital subtraction angiography. CUS parameters, including the end-diastolic ratio of the common carotid artery (CCA-ED ratio), end-diastolic flow velocity of the external carotid artery (ECA EDV), and the resistance index of the external carotid artery (ECA RI), were examined before and after treatment of CS-dAVF and TS-dAVF. A comparison of the CUS parameters before treatment showed increases in the CCA-ED ratio and ECA EDV and a decrease in the ECA RI in TS-dAVF patients. After treatment, the difference in the changes in TS-dAVF vs. CS-dAVF patients was significant. Thus, compared with before treatment, the CCA-ED ratio (pre: 1.80 vs. post: 1.38, p = 0.005) and ECA EDV (cm/s) (54.4 vs. 29.9, p = 0.001) decreased significantly in TS-dAVF patients, whereas the ECA RI was significantly higher in both TS-dAVF (0.60 vs. 0.72, p = 0.005) and CS-dAVF (0.76 vs. 0.85, p = 0.043) patients. These results demonstrated the utility of CUS in estimating the therapeutic effect of dAVF, especially in patients with TS-dAVF.