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O18/172  Dural arteriovenous fistulas with cognitive impairment: angiographic characteristics and treatment outcomes
  1. Sebastian Sanchez1,
  2. Linder Wendt2,
  3. Minako Hayakawa3,
  4. Santiago Ortega-Gutierrez4,
  5. Andres Gudino1,
  6. Katherine Guijarro-Falcon1,
  7. Chin-Jen Chen5,
  8. Jason Sheehan6,
  9. Louis Kim7,
  10. Isaac Josh Abecassis7,
  11. Michael Levitt7,
  12. R Michael Meyer7,
  13. Ridhima Guniganti8,
  14. Akash Kansagra9,
  15. Giuseppe Lanzino10,
  16. Enrico Giordan11,
  17. Waleed Brinjikji11,
  18. Diederik Bulters12,
  19. Andrew Durnford12,
  20. W Christopher Fox13,
  21. Jessica Smith14,
  22. Adam Polifka14,
  23. Bradley Gross15,
  24. Sepideh Amin-Hanjani16,
  25. Ali Alaraj16,
  26. Amanda Kwasnicki16,
  27. Robert Starke17,
  28. Stephanie Chen17,
  29. J Marc C van Dijk18,
  30. Adriaan Potsieger18,
  31. Junichiro Satomi19,
  32. Yoshiteru Tada19,
  33. Ryan Phelps20,
  34. Adib Abla20,
  35. Ethan Winkler20,
  36. Rose Du21,
  37. Pui Man Rosalind Lai21,
  38. Gregory Zipfel8,
  39. Colin P Derdeyn3,
  40. Edgar Samaniego4
  1. 1The University of Iowa, Neurology, Iowa City, USA
  2. 2Institute for Clinical and Translational Science, Biostatistics, Iowa City, USA
  3. 3The University of Iowa, Radiology, Iowa City, USA
  4. 4The University of Iowa, Neurology, Radiology and Neurosurgery, Iowa City, USA
  5. 5UTHealth Houston (The University of Texas Health Science Center at Houston), Neurosurgery, Houston, USA
  6. 6UVA University Hospital, Neurosurgery, Charlottesville, USA
  7. 7University of Washington, Neurosurgery, Seattle, USA
  8. 8Washington University in St. Louis, Neurosurgery, St. Louis, USA
  9. 9Washington University in St. Louis, Radiology, St. Louis, USA
  10. 10Mayo Clinic, Neurosurgery, Rochester, USA
  11. 11Mayo Clinic, Radiology, Rochester, USA
  12. 12University Hospital Southampton, Neurosurgery, Southampton, UK
  13. 13Mayo Clinic, Neurosurgery, Jacksonville, USA
  14. 14University of Florida, Neurosurgery, Gainesville, USA
  15. 15University of Pittsburgh, Neurosurgery, Pittsburgh, USA
  16. 16University of Illinois Chicago, Neurosurgery, Chicago, USA
  17. 17University of Miami, Neurosurgery, Miami, USA
  18. 18University of Groningen, Neurosurgery, Groningen, Netherlands
  19. 19Tokushima University Hospital, Neurosurgery, Tokushima, Japan
  20. 20University of California, San Francisco, Neurosurgery, San Francisco, USA
  21. 21Brigham and Women’s Hospital, Neurosurgery, Boston, USA


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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