Alan Mendez-Ruiz1, Waldo R Guerrero2, Viktor Szeder3, Mudassir Farooqui1, Cynthia B Zevallos1, Darko Quispe-Orozco1, Santiago Ortega-Gutierrez1,4. 1. Department of Neurology, 21782University of Iowa Hospitals and Clinics, USA. 2. Department of Neurosurgery, 7831University of South Florida Morsani College of Medicine, USA. 3. Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, 12222University of California, Los Angeles, USA. 4. Department of Radiology and Neurosurgery, 21782University of Iowa Hospitals and Clinics, USA.
Abstract
INTRODUCTION: Endovascular therapy has shown to be safe and effective for the treatment of cerebral dural arteriovenous fistulas; however, recurrence after complete occlusion is not uncommon, and the timing of recurrence remains unknown. METHODS: A retrospective single-center cohort study was conducted from January 2005 to December 2020. Patients with high-grade (≥Borden II-Cognard IIB) dural arteriovenous fistulas treated with endovascular therapy were included in this study. Clinical and angiographic characteristics were collected for hospitalization and at follow-up. RESULTS: A total of 51 patients with a median age of 61 years were studied; 57% were female. High-flow symptoms related to the high-flow fistula were the most common presentation (67%), and 24% presented with intracranial hemorrhage. Transverse-sigmoid (26%) and cavernous (26%) sinuses were the most common dural arteriovenous fistula locations. A total of 40 patients (70%) had middle meningeal arterial feeders and 4 (7%) had deep cerebral venous drainage. The mean number of embolization procedures per patient was 1.4. Transarterial access was the most frequent approach (61%). Onyx alone was the most common embolic agent (26%). Complete occlusion rate was achieved in 46 patients (80.1%). Last mean radiographic follow-up time was 26.7 months for all 57 dural arteriovenous fistulas. Dural arteriovenous fistula recurrence after radiographic resolution at last treatment was seen in six cases (6/46, 13.1%). Mean time for recurrence was 15.8 months. Mean time of last clinical follow-up was 46.1 months for the 51 patients (100%). A total of 10 (20%) experienced any procedural complications, among which two (4%) became major thromboembolic events. CONCLUSION: Endovascular therapy is safe and effective for the treatment of high-grade dural arteriovenous fistulas. Given the significant recurrence rate of embolized dural arteriovenous fistulas even after 2 years, long-term angiographic follow-up might be needed.
INTRODUCTION: Endovascular therapy has shown to be safe and effective for the treatment of cerebral dural arteriovenous fistulas; however, recurrence after complete occlusion is not uncommon, and the timing of recurrence remains unknown. METHODS: A retrospective single-center cohort study was conducted from January 2005 to December 2020. Patients with high-grade (≥Borden II-Cognard IIB) dural arteriovenous fistulas treated with endovascular therapy were included in this study. Clinical and angiographic characteristics were collected for hospitalization and at follow-up. RESULTS: A total of 51 patients with a median age of 61 years were studied; 57% were female. High-flow symptoms related to the high-flow fistula were the most common presentation (67%), and 24% presented with intracranial hemorrhage. Transverse-sigmoid (26%) and cavernous (26%) sinuses were the most common dural arteriovenous fistula locations. A total of 40 patients (70%) had middle meningeal arterial feeders and 4 (7%) had deep cerebral venous drainage. The mean number of embolization procedures per patient was 1.4. Transarterial access was the most frequent approach (61%). Onyx alone was the most common embolic agent (26%). Complete occlusion rate was achieved in 46 patients (80.1%). Last mean radiographic follow-up time was 26.7 months for all 57 dural arteriovenous fistulas. Dural arteriovenous fistula recurrence after radiographic resolution at last treatment was seen in six cases (6/46, 13.1%). Mean time for recurrence was 15.8 months. Mean time of last clinical follow-up was 46.1 months for the 51 patients (100%). A total of 10 (20%) experienced any procedural complications, among which two (4%) became major thromboembolic events. CONCLUSION: Endovascular therapy is safe and effective for the treatment of high-grade dural arteriovenous fistulas. Given the significant recurrence rate of embolized dural arteriovenous fistulas even after 2 years, long-term angiographic follow-up might be needed.
Authors: Ching-Jen Chen; Thomas J Buell; Dale Ding; Ridhima Guniganti; Akash P Kansagra; Giuseppe Lanzino; Waleed Brinjikji; Louis Kim; Michael R Levitt; Isaac Josh Abecassis; Diederik Bulters; Andrew Durnford; W Christopher Fox; Adam J Polifka; Bradley A Gross; Minako Hayakawa; Colin P Derdeyn; Edgar A Samaniego; Sepideh Amin-Hanjani; Ali Alaraj; Amanda Kwasnicki; J Marc C van Dijk; Adriaan R E Potgieser; Robert M Starke; Stephanie Chen; Junichiro Satomi; Yoshiteru Tada; Adib Abla; Ryan R L Phelps; Rose Du; Rosalind Lai; Gregory J Zipfel; Jason P Sheehan Journal: Neurosurgery Date: 2021-05-13 Impact factor: 4.654
Authors: D F Vollherbst; C Ulfert; U Neuberger; C Herweh; M Laible; S Nagel; M Bendszus; M A Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2018-05-03 Impact factor: 3.825
Authors: Guilherme Dabus; Peter Kan; Carlos Diaz; Boris Pabon; Juan Andres-Mejia; Italo Linfante; Jonathan A Grossberg; Brian M Howard; Civan Islak; Naci Kocer; Osman Kizilkilic; Ajit S Puri; Anna L Kuhn; Viraj Moholkar; Santiago Ortega-Gutierrez; Edgar A Samaniego; Michael W McDermott Journal: Neuroradiology Date: 2020-08-25 Impact factor: 2.804