Wall Shear Stress in the Feeding Native Conduit Arteries of Superficial Arteriovenous Malformations of the Lower Face is a Reliable Marker of Disease Progression

Author:

El sanharawi Imane1,Barral Matthias2,Lenck Stéphanie3,Dillinger Jean Guillaume4,Salvan Didier4,Mangin Gabrielle2,Cogo Adrien2,Bailliart Olivier1,Levy Bernard I.5,Kubis Nathalie1,Bisdorff-Bresson Annouk3,Bonnin Philippe1

Affiliation:

1. APHP, Clinical Physiology – Functional Investigations, Lariboisiere Hospital, Paris, France

2. UMR965, CART, INSERM, Lariboisiere Hospital, Paris, France

3. APHP, Neuroradiology, center for arteriovenous malformations in children and adults, Lariboisiere Hospital, Paris, France

4. APHP, Otorhinolaryngology and maxillofacial surgery, Lariboisiere Hospital, Paris, France

5. Lariboisiere Hospital, Vessel and Blood Institut, Paris, France

Abstract

Abstract Purpose To assess the prognostic value of the wall shear stress (WSS) measured in the feeding native arteries upstream from facial superficial arteriovenous malformations (sAVMs). Reliable prognostic criteria are needed to distinguish progressive from stable sAVMs and thus support the indication for an aggressive or a conservative management to avoid severe facial disfigurement. Materials and Methods We prospectively included 25 patients with untreated facial sAVMs, 15 patients with surgically resected sAVMs and 15 controls. All had undergone Doppler ultrasound examination (DUS) with measurements of inner diameters, blood flow velocities, computation of blood flow and WSS of the feeding arteries. Based on the absence or presence of progression in clinical and imaging examinations 6 months after, we discriminated untreated patients as stable or progressive. Results WSS in the ipsilateral external carotid artery was higher in progressive compared to stable sAVMs (15.8 ± 3.3dynes/cm² vs. 9.6 ± 2.0dynes/cm², mean±SD, p < 0.0001) with a cut-off of 11.5dynes/cm² (sensitivity: 92 %, specificity: 92 %, AUC: 0.955, [95 %CI: 0.789–0.998], p = 0.0001). WSS in the ipsilateral facial artery was also higher in progressive compared to stable sAVMs (50.7 ± 14.5dynes/cm² vs. 25.2 ± 7.1dynes/cm², p < 0.0001) with a cut-off of 34.0dynes/cm² (sensitivity: 100 %, specificity: 92 %, AUC: 0.974, [95 %CI: 0.819–1.000], p = 0.0001). The hemodynamic data of operated patients were not different from those of the control group. Conclusion WSS measured in the feeding arteries of an sAVM may be a simple reliable criterion to distinguish stable from progressive sAVMs. This value should be considered to guide the therapeutic strategy as well as the long-term follow-up of patients with facial sAVMs.

Publisher

Georg Thieme Verlag KG

Subject

Radiology Nuclear Medicine and imaging

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