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New devices and techniques
Original research
The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration
  1. Andrea Becerril-Gaitan1,
  2. Dale Ding2,
  3. Natasha Ironside3,
  4. Thomas J Buell4,
  5. Akash P Kansagra5,
  6. Giuseppe Lanzino6,
  7. Waleed Brinjikji6,
  8. Louis Kim7,
  9. Michael R Levitt7,
  10. Isaac Josh Abecassis2,
  11. Diederik Bulters8,
  12. Andrew Durnford8,
  13. W Christopher Fox9,
  14. Spiros Blackburn1,
  15. Peng Roc Chen1,
  16. Adam J Polifka10,
  17. Dimitri Laurent10,
  18. Bradley Gross4,
  19. Minako Hayakawa11,
  20. Colin Derdeyn11,
  21. Sepideh Amin-Hanjani12,
  22. Ali Alaraj13,
  23. J Marc C van Dijk14,
  24. Adriaan R E Potgieser14,
  25. Robert M Starke15,16,
  26. Eric C Peterson15,
  27. Junichiro Satomi17,
  28. Yoshiteru Tada17,
  29. Adib A Abla18,
  30. Ethan A Winkler18,
  31. Rose Du19,
  32. Pui Man Rosalind Lai19,
  33. Gregory J Zipfel5,
  34. Ching-Jen Chen1,
  35. Jason P Sheehan3
  36. On behalf of CONDOR investigators
  1. 1 Neurosurgery Department, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  2. 2 Neurosurgery Department, University of Louisville, Louisville, Kentucky, USA
  3. 3 Neurosurgery Department, University of Virginia Health System, Charlottesville, Virginia, USA
  4. 4 Neurosurgery Department, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5 Neurosurgery Department, Washington University School of Medicine, St. Louis, Missouri, USA
  6. 6 Neurosurgery Department, Mayo Clinic, Rochester, Minnesota, USA
  7. 7 Neurosurgery Department, University of Washington, Seattle, Washington, USA
  8. 8 Neurosurgery Department, University of Southampton, Southampton, UK
  9. 9 Neurosurgery Department, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
  10. 10 Neurosurgery Department, University of Florida, Gainesville, Florida, USA
  11. 11 Radiology and Interventional Radiology Department, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  12. 12 Neurosurgery Department, University Hospitals/Case Western Reserve University, Cleveland, Ohio, USA
  13. 13 Neurosurgery Department, University of Illinois Chicago, Chicago, Illinois, USA
  14. 14 Neurosurgery Department, University of Groningen, Groningen, The Netherlands
  15. 15 Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida, USA
  16. 16 Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
  17. 17 Neurosurgery Department, University of Tokushima, Tokushima, Japan
  18. 18 Neurosurgery Department, University of California San Francisco, San Francisco, California, USA
  19. 19 Neurosurgery Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Jason P Sheehan, Neurosurgery Department, University of Virginia Health System, Charlottesville, Virginia, USA; JPS2F{at}uvahealth.org

Abstract

Background Tools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes.

Methods Patients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC.

Results A total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27–1.48)) with each additional point in the overall patient score (range 0–12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0–3 score to 72–89% for patients scoring ≥8.

Conclusion The VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.

  • Fistula
  • Hemorrhage
  • Intervention
  • Stroke

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-020282

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @abega95, @AkashKansagra, @DrMichaelLevitt, @drjoshabecassis, @wchrisfox, @dlaurent955, @CPDerdeyn, @Starke_neurosurgery, @Junichiro Satomi, @rosalind_lai, @chenjared

    • Collaborators CONDOR Collaborators. University of Texas Health Science Center: Ching-Jen Chen, MD. Washington University School of Medicine: Gregory J. Zipfel, MD; Akash P. Kansagra, MD, MS; Ridhima Guniganti, MD; Jay F. Piccirillo, MD; Hari Raman, MD; Kim Lipsey. Mayo Clinic, Rochester: Giuseppe Lanzino, MD; Waleed Brinjikji, MD; Roanna Vine, RN; Harry J. Cloft, MD; David F. Kallmes, MD; Bruce E. Pollock, MD; Michael J. Link, MD. Mayo Clinic, Jacksonville: W. Christopher Fox, MD. University of Virginia Health System: Jason P. Sheehan, MD, PhD.; Mohana Rao Patibandla, MCh; Dale Ding, MD; Gabriella Paisan, MD. University of Washington: Louis J. Kim, MD, MBA; Michael R. Levitt, MD; Isaac Josh Abecassis, MD; R. Michael Meyer IV, MD; Cory Kelly. University of Southampton: Diederik Bulters, FRCS(SN); Andrew Durnford, MA, MSc, FRCS; Jonathan Duffill, MBChB; Adam Ditchfield, MBBS; John Millar, MBBS; Jason Macdonald, MBBS. University of Florida: Adam J. Polifka, MD; Dimitri Laurent, MD; Brian Hoh, MD; Jessica Smith, MSN, RN; Ashley Lockerman, RN. University of Pittsburgh: Thomas Buell, MD; Bradley A. Gross, MD; L. Dade Lunsford, MD; Brian T. Jankowitz, MD. University of Iowa Hospitals and Clinics: Minako Hayakawa, MD, PhD; Colin P. Derdeyn, MD; Edgar A. Samaniego, MD; Santiago Ortega Gutierrez, MD, MS; David Hasan, MD; Jorge A. Roa, MD; James Rossen, MD; Waldo Guerrero, MD; Allen McGruder. University Hospitals Cleveland Medical Center/Case Western Reserve University: Sepideh Amin-Hanjani, MD. University of Illinois at Chicago: Ali Alaraj, MD; Amanda Kwasnicki, MD; Fady T. Charbel, MD; Victor A. Aletich, MS, MD (posthumous); Linda Rose-Finnell. University of Groningen, University Medical Center Groningen: J. Marc C. van Dijk, MD, PhD; Adriaan R. E. Potgieser, MD, PhD. University of Miami: Robert M. Starke, MD, MSc; Eric C. Peterson, MD; Dileep R. Yavagal, MD; Samir Sur, MD; Stephanie H. Chen, MD. Tokushima University: Junichiro Satomi, MD, PhD; Yoshiteru Tada, MD, PhD; Yasuhisa Kanematsu, MD, PhD; Nobuaki Yamamoto, MD, PhD; Tomoya Kinouchi, MD, PhD; Masaaki Korai, MDPhDhD; Izumi Yamaguchi, MDPhDhD; Yuki Yamamoto, MD. University of California, San Francisco: Adib Abla, MD; Ethan Winkler, PhD; Ryan R. L. Phelps, BA; Michael Lawton, MD; Martin Rutkowski, MD. Brigham and Women’s Hospital: Rose Du, PhD; Pui Man Rosalind Lai, MD; M. Ali Aziz-Sultan, MD; Nirav Patel, MD; Kai U. Frerichs, MD.

    • Contributors Conception and design: JPS, CJC. Acquisition of data: all authors. Analysis and interpretation: ABG, CJC. Drafting the article: ABG, CJC. Critically revising the article: all authors. Approval of final manuscript: all authors. Study supervision: CJC, JPS. Overall content guarantor: JPS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Dr. Kansagra is a consultant for Medtronic, Microvention, and Penumbra. Dr. Lanzino is a consultant for Superior Medical Editing. Dr. Kim is a MicroVention consultant, cofounder of SPI Surgical, and has NINDS grants. Dr. Levitt is a consultant for Medtronic and Minnetronix; he has NINDS, AHA, Stryker, and Medtronic grants and equity interest in Proprio. Dr. Gross is a MicroVention and Medtronic consultant. Dr. Derdeyn is a consultant for Penumbra, Genae, and Nono, and receives the support of non-study-related clinical or research efforts from Siemens Healthineers. Dr. Alaraj is a consultant for Cerenovus and Siemens, and has an NIH grant. Dr. Starke has consulting teaching agreements with Penumbra, Abbott, Medtronic, InNeruCo, and Cerenovus. Dr. Peterson is a consultant for Stryker, Penumbra, Medtronic, and Cerenovus, and has a stockholder in RIST Neurovascular. Dr. Samaniego is a MicroVention consultant. Dr. Piccirillo is a Bind-On-Demand insurance medical officer. Dr. Charbel is a Transonic consultant. Dr. Yavagal is a Medtronic, Cerenovus, Rapid Medical, and Neural Analytics consultant. The other authors have no personal, financial, or institutional interests to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.