Introduction Several small series have described cases of patients with dural arteriovenous fistulas (dAVFs) presenting with rapidly progressively dementia. The angioarchitecture of dAVFs that lead to cognitive impairment is unknown.
Aim of Study To determine the angiographic characteristics of dAVFs that lead to cognitive impairment (dAVF-CI).
Methods We analyzed the CONDOR database. CONDOR is an international multicenter database that includes 1077 dAVFs. Data from patients with dAVFs that presented with cognitive impairment were analyzed. A propensity score matching analysis of Borden type II and type III dAVFs that presented either with or without cognitive impairment (control) was performed. Logistic regression was performed to identify characteristics of dAVF-CI.
Results A total of 60 dAVFs-CI and 60 control dAVFs were analyzed. The mean age of patients with dAVF-CI was 58 ± 18 years. Venous hypertension was present in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85 95% CI: 1.16–7.55, p = 0.027). dAVFs-CI are characterized by multiple arteriovenous shunts with more arterial feeders (OR 1.56, 95% CI 1.22–2.05, p <0.001) and draining veins (OR 2.05, 95% CI 1.05–4.46, p=0.049). Venous ectasia was associated with dAVFs-CI (OR 2.38, 95% CI 1.13–5.11, p = 0.024). dAVF closure was associated with symptom resolution at follow-up (OR 2.86, 95% CI 0.85–9.56, p=0.09).
Conclusion Venous hypertension is a characteristic present in all dAVFs-CI. Sinus stenosis and venous ectasia impair drainage and favor venous hypertension. Successful treatment may reverse symptoms before infarction occurs.
Disclosure of Interest Nothing to disclose.
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