Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort

Guniganti, Ridhima; Giordan, Enrico; Chen, Ching-Jen; Abecassis, Isaac Josh; Levitt, Michael R.; Durnford, Andrew; Smith, Jessica; Samaniego, Edgar A; Derdeyn, Colin P.; Kwasnicki, Amanda; Alaraj, Ali; Potgieser, Adriaan R E; Sur, Samir; Chen, Stephanie H.; Tada, Yasuyuki; Winkler, Ethan A.; Phelps, Ryan R.L.; Lai, Pui Man Rosalind; Du, Rose; Abla, Adib A.; Satomi, Junichiro; Starke, Robert M.; Dijk, J. Marc C. van; Amin‐Hanjani, Sepideh; Hayakawa, Minako; Gross, Bradley A.; Fox, W. Christopher; Bulters, Diederik; Kim, Louis J.; Sheehan, Jason P.; Lanzino, Giuseppe; Piccirillo, Jay F.; Kansagra, Akash P.; Zipfel, Gregory J.

doi:10.3171/2021.1.jns202790

Cited by 17 publications

(18 citation statements)

References 47 publications

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“…As previously described, the CONDOR database is a comprehensive repository that gathers data about dAVFs from 12 centers 14. Before data collection, approval from the institutional review boards at each institution was obtained.…”

Section: Methodsmentioning

confidence: 99%

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Sanchez

Raghuram

Wendt

et al. 2022

J NeuroIntervent Surg

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BackgroundAnterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs.MethodsThe CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990–2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed.Results60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs.ConclusionMost ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.

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Section: Methodsmentioning

confidence: 99%

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Sanchez

Raghuram

Wendt

et al. 2022

J NeuroIntervent Surg

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“…Patients with angiographically confirmed dAVFs who presented to one of the 14 CONDOR-participating institutions were retrospectively reviewed under each center’s Institutional Review Board protocols. The formation and methodology of the CONDOR database have been previously described 8. Data from each institution were de-identified and pooled by the coordinating center.…”

Section: Methodsmentioning

confidence: 99%

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

Becerril-Gaitan

Ding

Ironside

et al. 2023

J NeuroIntervent Surg

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BackgroundTools 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.MethodsPatients 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.ResultsA 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.ConclusionThe 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.

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“…The infrastructure for CONDOR is described elsewhere in detail. 39 Briefly, collaborating institutions obtained individual institutional review board approval to conduct a retrospective analysis of all dAVFs treated at each institution. Details were collected from the clinical record and imaging databases, de-identified, and shared via a third-party host institution.…”

Section: Methodsmentioning

confidence: 99%

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

Abecassis¹,

Meyer²,

Levitt³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

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Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort

Cited by 17 publications

References 47 publications

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

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