A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply

Sato, Kenichi; Matsumoto, Yasushi; Endo, Hidenori; Tominaga, Teiji

doi:10.1177/1591019917694839

Cited by 30 publications

(18 citation statements)

References 24 publications

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“…Hemorrhagic complication after the endovascular treatment of the DAVFs has been reported in recent literatures with an incidence rate of 0-3.8%. 2,3 In this study, the hemorrhagic complication rate after the endovascular embolization was 4.5% (12/267), which was not eligible in DAVF treatment. In 2017, Sadeh-Gonike U et al 5 of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 and found the rate of hemorrhagic complications rate was 0%.…”

Section: Discussionmentioning

confidence: 73%

“…DAVFs with pial venous drainage or venous aneurysm are risk factors for hemorrhagic presentation in patients with DAVF. [2][3][4] Management of DAVFs includes open surgery, radiosurgery, endovascular embolization, or a combination of these modalities. Endovascular Onyx embolization has now been accepted as the primary treatment strategy to manage DAVFs.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10] There is still a lack of detailed information concerning the incidence and risk factors of hemorrhagic complications related to endovascular procedures. [2][3][4]6 In this article, we analyzed the possible risk factors for the hemorrhagic complication caused by endovascular embolization of DAVFs.…”

Section: Introductionmentioning

confidence: 99%

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Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

et al. 2020

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Background and purpose Hemorrhagic complication is a disastrous complication of intracranial dural arteriovenous fistulas (DAVFs) embolization. This study was to analyze the possible risk factors for the hemorrhagic complication caused by endovascular embolization of DAVFs. Methods From January 2012 to July 2016, a total of 267 patients with intracranial DAVFs received endovascular Onyx embolization at our hospital. The demographic information, clinical presentation, angiographic features, endovascular treatment and hemorrhagic complications were reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors contributing to the post-procedural hemorrhagic complications. Results In 267 patients of DAVF treated with endovascular embolization, procedure-related hemorrhagic complication occurred in 12 (4.5%) patients. Univariate and multivariate logistic regression analyses showed that the pial arterial supplier (OR 13.630; 95% CI, 1.556–119.368; P = 0.018), giant venous aneurysm (OR 15.196; 95% CI, 2.505–92.183; P = 0.003) and Onyx volume ≥ 6 ml (OR 1.138; 95% CI, 1.006–1.288; P = 0.040) were significant factors associated with these hemorrhagic complications. Conclusions Hemorrhagic complications associated with endovascular DAVF embolization are not negligible. The pial arterial supplier, giant venous aneurysm and higher Onyx volume in one session may be risk factors for endovascular DAVF embolization.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

et al. 2020

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“…There are reports of hemorrhagic complications with transarterial Onyx embolization of intracranial dural AVFs with pial feeder. 12,13 However, all of the reported three cases were located in the tentorium and associated with special angioarchitecture, which may not apply to CCJ AVFs; one had drainage into the vein of Galen and the basal vein of Rosenthal with venous varix, another had pathologically demonstrated vascular malformation and the other had subdural extension of glomus-like vasculature. In fact, the previous case report successfully treated CCJ epidural AVF with a pial feeder aneurysm by clipping venous outlet without hemorrhage.…”

Section: Discussionmentioning

confidence: 98%

Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

et al. 2019

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Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

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“…The target of this treatment regimen is complete occlusion of the fistula with cortical venous reflux ( 24 ). During endovascular embolization, if the embolic agent completely occludes the fistula by crossing into the immediate receptive venous structure, an adequate outcome can be achieved ( 56 ). Endovascular embolization may be performed using different types of embolic agents and a variety of routes.…”

Section: Treatmentmentioning

confidence: 99%

Progress in research on intracranial multipleï¿½duralï¿½arteriovenous fistulas (Review)

Guo

Zhao

et al. 2017

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Intracranial multiple dural arteriovenous fistulas (MDAVFs) are rare lesions that are difficult to treat. The key factors involved in the development of MDAVFs remain unknown. At present, the majority of reports on intracranial MDAVFs are confined to case reports and small case series, and thus understanding of MDAVFs is limited. The current review assesses the available literature to date with the aim of reviewing the progress in research on intracranial MDAVFs. Intracranial MDAVFs may be divided into two types: Synchronous and metachronous. While the exact pathogenesis of MDAVFs is unknown, a number of possible mechanisms are considered relevant. The first is that MDAVFs develop following recanalization of a large sinus thrombosis that involves several sinuses. The second possibility is that a pre-existing DAVF may induce sinus thrombosis or venous hypertension, resulting in a new MDAVF. The third is that MDAVFs are caused by increased angiogenic activity, which may induce the development of MDAVFs. Intracranial MDAVFs have a malignant clinical course, and their symptoms generally rapidly progress following onset. It is therefore important to identify intracranial MDAVFs at an early stage. A number of imaging technologies, including computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and single-photon emission computed tomography (SPECT), may be used to detect MDAVFs. Of these, CT and MRI provide information on brain morphology, SPECT provides brain blood flow information, and DSA is the gold standard that may be used to identify angioarchitecture and hemodynamics. MDAVFs require timely and aggressive treatment, which may include endovascular embolization, surgical resection, radiosurgery and conservative treatment, and in some cases, combined treatments are required. Appropriate and aggressive treatment regimens can markedly improve neurological deficits and cognitive function in patients with MDAVFs.

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A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply

Cited by 30 publications

References 24 publications

Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

Progress in research on intracranial multipleï¿½duralï¿½arteriovenous fistulas (Review)

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