Background and purpose Transarterial Onyx embolization is an effective treatment for patients with intracranial dural arteriovenous fistula (DAVF). A study was performed to determine whether the clinical and radiological outcomes after transarterial Onyx treatment were affected by the type of cortical venous drainage (direct vs indirect) of high-grade DAVF.
Materials and methods Between May 2006 and December 2014, demographic data, clinical presentation, angiographic characteristics, and treatment-related outcomes were collected for 54 patients divided into two groups (intracranial DAVF with direct and indirect cortical venous drainage). Continuous variables were compared with the two-tailed t test and categorical variables with the χ2 test. Statistical significance was set at P<0.05.
Results Fifty-two patients (71% with direct and 29% with indirect cortical venous drainage) underwent Onyx embolization. Immediate complete occlusion after treatment was observed in about 55% of patients without between-group difference. During the long-term follow-up, complete angiographic occlusion was achieved in 83% of patients. Specifically, 15 additional patients (40%) in the direct cortical venous drainage group progressed to complete occlusion, but only one (6%) in the indirect cortical venous drainage group. Overall, the rate of complete occlusion was higher in patients with DAVF with direct cortical venous drainage (92%) than in those with DAVF with indirect cortical venous drainage (62.5%) (P=0.01). The rate of permanent treatment-related complications was 4%, mostly related to ischemic events. Overall, 80.5% of patients had a good neurological outcome (modified Rankin Scale score 0–2).
Conclusions Transarterial Onyx embolization of intracranial high-grade DAVF is safe and effective, particularly for lesions with direct cortical venous drainage.
- liquid embolic material
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Contributors DM, MLC, PHL, AB: Participated in the conception and design of the study. DM, PHL, MLC, FC, AB: Analyzed and interpreted the data. GG, OE, CR, CD, PM, VC: Collection, assembly, and possession of the raw data. CD, OE, VC, FC: Statistical expertise. DM, PHL, FC: Initial drafting of the article. PHL, FC, AB: Revision of article. DM, GG, OE, CR, CD, PM, AB: Revising the manuscript critically for important intellectual content.
Funding This research received no specific grant from any funding agency in the public, commercial or not- for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.