Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)
| Autor: | Isaac Josh Abecassis, R. Michael Meyer, Michael R. Levitt, Jason P. Sheehan, Ching-Jen Chen, Bradley A. Gross, Jessica Smith, W. Christopher Fox, Enrico Giordan, Giuseppe Lanzino, Robert M. Starke, Samir Sur, Adriaan R. E. Potgieser, J. Marc C. van Dijk, Andrew Durnford, Diederik Bulters, Junichiro Satomi, Yoshiteru Tada, Amanda Kwasnicki, Sepideh Amin-Hanjani, Ali Alaraj, Edgar A. Samaniego, Minako Hayakawa, Colin P. Derdeyn, Ethan Winkler, Adib Abla, Pui Man Rosalind Lai, Rose Du, Ridhima Guniganti, Akash P. Kansagra, Gregory J. Zipfel, Louis J. Kim, Jay F. Piccirillo, Hari Raman, Kim Lipsey, Waleed Brinjikji, Roanna Vine, Harry J. Cloft, David F. Kallmes, Bruce E. Pollock, Michael J. Link, Jason Sheehan, Mohana Rao Patibandla, Dale Ding, Thomas Buell, Gabriella Paisan, Cory Kelly, Jonathan Duffill, Adam Ditchfield, John Millar, Jason Macdonald, Adam J. Polifka, Dimitri Laurent, Brian Hoh, Ashley Lockerman, L. Dade Lunsford, Brian T. Jankowitz, Santiago Ortega Gutierrez, David Hasan, Jorge A. Roa, James Rossen, Waldo Guerrero, Allen McGruder, Fady T. Charbel, Victor A. Aletich, Linda Rose-Finnell, Eric C. Peterson, Dileep R. Yavagal, Stephanie H. Chen, Yasuhisa Kanematsu, Nobuaki Yamamoto, Tomoya Kinouchi, Masaaki Korai, Izumi Yamaguchi, Yuki Yamamoto, Ryan R. L. Phelps, Michael Lawton, Martin Rutkowski, M. Ali Aziz-Sultan, Nirav Patel, Kai U. Frerichs |
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| Přispěvatelé: | Movement Disorder (MD) |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
recurrence medicine.medical_treatment Arteriovenous fistula Multimodality Therapy vascular disorders Radiosurgery Primary outcome Dural arteriovenous fistulas medicine Humans Risk factor dural arteriovenous fistula Neurological deficit Retrospective Studies Central Nervous System Vascular Malformations business.industry Skull General Medicine medicine.disease re-treatment EMBOLIZATION Embolization Therapeutic Surgery Cerebral Angiography ONYX Treatment Outcome Outcomes research business |
| Zdroj: | Journal of Neurosurgery, 136(4), 981-989. AMER ASSOC NEUROLOGICAL SURGEONS |
| ISSN: | 0022-3085 |
| Popis: | OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases). RESULTS Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision). CONCLUSIONS Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence. |
| Databáze: | OpenAIRE |
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