RT Journal Article
SR Electronic
T1 Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 958
OP 963
DO 10.1136/neurintsurg-2017-013476
VO 10
IS 10
A1 Daniel Mantilla
A1 Marine Le Corre
A1 Federico Cagnazzo
A1 Gregory Gascou
A1 Omer Eker
A1 Paolo Machi
A1 Carlos Riquelme
A1 Cyril Dargazanli
A1 Vincent Costalat
A1 Alain Bonafe
A1 Pierre-Henri Lefevre
YR 2018
UL http://jnis.bmj.com/content/10/10/958.abstract
AB 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.