Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

Autor: Lukas Goertz, Anushe Weber, Werner Weber, Finn Drescher, Sebastian Fischer, Volker Maus
Rok vydání: 2020
Předmět:
Adult
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
Time Factors
Fistula
dural fistulas
endovascular interventional neuroradiology
030204 cardiovascular system & hematology
Single Center
Embolic Agent
03 medical and health sciences
0302 clinical medicine
Dural arteriovenous fistulas
Germany
Occlusion
medicine
Humans
vascular malformations
Sinus (anatomy)
Aged
Retrospective Studies
Central Nervous System Vascular Malformations
business.industry
Mortality rate
Endovascular Procedures
Middle Aged
medicine.disease
Embolization
Therapeutic
Surgery
Translational Research in Stroke
Treatment Outcome
medicine.anatomical_structure
Neurology
lcsh:RC666-701
Retreatment
Dural venous sinuses
Female
vascular radiology
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Zdroj: Cerebrovascular Diseases Extra, Vol 10, Iss 2, Pp 84-93 (2020)
Cerebrovascular Diseases Extra
ISSN: 1664-5456
DOI: 10.1159/000509455
Popis: Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.
Databáze: OpenAIRE
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