Endovascular embolization of high-grade cerebral dural arteriovenous fistulas - assessment of long-term recurrences.

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.

• Authors: Alan Mendez-Ruiz, Waldo R Guerrero, Viktor Szeder, Mudassir Farooqui, Cynthia B Zevallos, Darko Quispe-Orozco, Santiago Ortega-Gutierrez
• Journal: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences (Interv Neuroradiol) Vol. 28 Issue 4 Pg. 411-418 (Aug 2022) ISSN: 2385-2011 [Electronic] United States
• PMID: 34516298 (Publication Type: Journal Article)

Chemical References

• Polyvinyls

Topics

• Central Nervous System Vascular Malformations (drug therapy, therapy)
• Cerebral Angiography
• Cohort Studies
• Embolization, Therapeutic (methods)
• Endovascular Procedures (methods)
• Female
• Humans
• Male
• Middle Aged
• Polyvinyls (therapeutic use)
• Retrospective Studies
• Treatment Outcome