Blood PTX was higher when using 3.0 µg/mm(2) DCB, with a peak drug concentration at 1-min, although the drug was undetectable at 24 h, independently of the loading dose. This study demonstrates no difference in arterial wall uptake of a low dose DCB (1.0 µg/mm(2)), when compared to a common dose DCB (3.0 µg/mm(2)) suggesting that the dose of drug in the DCB could be reduced obtaining a similar clinical effect.
Endovascular therapy could be a safe and effective option for AVM as long as it includes not only feeding vessels embolization but also complete occlusion of the nidus.
Introduction:
Dural arteriovenous fistulae (dAVF) are rare acquired intracranial vascular malformations with clinical manifestations varying from asymptomatic lesions, non-hemorrhagic neurological disorders, and intracranial hemorrhage which may be fatal. In addition, patients with dAVF often have cognitive impairments. This study assessed whether endovascular embolization improves cognitive performance in patients with dAVF.
Methods:
NAIF was a prospective study including all the patients with a clinical diagnosis of dAVF (excluding those with acute intracranial hemorrhage secondary to venous hypertension) who underwent successful embolization at 5 hospitals in Spain between January 4, 2018 and January 7, 2020. Patients were categorized by risk of hemorrhage (Cognard classification 1-2A and 2B-4) via angiography. A neuropsychological evaluation covering 5 domains of cognitive function (memory, attention and executive functions, language, praxis, gnosis) was completed at baseline and a 3-month follow-up. Paired sample t-tests were used to compare mean Z-scores for cognitive tests pre- and post-treatment, where higher Z-scores signify better cognitive status.
Results:
A preliminary group of 15 patients (mean age 60, [range 23-83 years], 4 [26.7%] female) were included. Six patients presented with low hemorrhagic risk (Cognard1-2A) and 9 with high hemorrhagic risk (Cognard 2B-4). In the post-treatment neuropsychological evaluation, patients exhibited improved performance in executive function in the Semantic and Phonetic Fluency test (-0.57 vs. 0.21; p=0.01) and increased performance in Verbal Memory Learning (-1.45 vs. -0.82; p=0.014) relative to baseline. The remaining cognitive evaluations did not show significant differences, although there was a trend of language improvement in the Boston naming test (0.95 vs. 1.12; p=0.093). Improvements were observed in both high- and low-risk patients, and no patients experienced cognitive worsening after the intervention.
Conclusion:
This study suggests that endovascular embolization imparts cognitive benefits for dAVF patients undergoing endovascular embolization, and may be beneficial even for patients with a low risk of hemorrhage.
Significant venous outflow stenosis of a forearm arteriovenous fistulae caused by an extrinsic vascular compression is a very rare entity (no reported cases in the literature). We report a case of high venous pressures during dialysis, secondary to an extrinsic compression of the underlying brachial artery that was diagnosed with Doppler ultrasound. The stenosis localization resembles the typical and frequent juxta-anastomotic venous outflow stenosis. This similarity can be a confounding factor and can lead to failure of conventional treatments. Careful surgical technique of arteriovenous graft creation and Doppler ultrasound mapping can prevent this entity.
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