Embolization of cranial dural arteriovenous fistulas in the liquid embolic era: A Sydney experience

Johnson, Catherine S.; Chiu, Albert Hy; Cheung, Andrew; Wenderoth, Jason

doi:10.1016/j.jocn.2017.12.007

Cited by 8 publications

(16 citation statements)

References 23 publications

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“…However, cranial nerve palsy is a rare but regularly observed complication after endovascular embolization of DAVFs. The rate of cranial nerve palsy lies between 0% and 6% 4,7,8,10,11,21 in the latest studies, with a pooled rate of 2% according to the above-mentioned meta-analysis of Sadeh-Gonike et al 22 Both of the 2 fatal complications in our study were large intracranial hemorrhages. One of these cases occurred after subtotal embolization of a high-grade DAVF, which should be avoided in any case, if possible.…”

Section: Discussionsupporting

confidence: 47%

The Influence of Angioarchitectural Features on the Success of Endovascular Embolization of Cranial Dural Arteriovenous Fistulas with Onyx

Vollherbst¹,

Herweh²,

Schönenberger

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Endovascular embolization can be an effective treatment for cranial dural arteriovenous fistulas. However, a considerable number of dural arteriovenous fistulas still cannot be treated sufficiently. The purpose of this study was to report our single-center experience of endovascular embolization of dural arteriovenous fistulas with Onyx, including the investigation of the influence of angioarchitectural features on the treatment success. MATERIALS AND METHODS: Clinical data, angioarchitectural features, complications, treatment success (defined as complete symptom remission for low-grade dural arteriovenous fistulas and complete occlusion for high-grade dural arteriovenous fistulas), and occlusion rates were assessed. The influence of various angioarchitectural features (including location, pattern of venous drainage, and quantity and origin of feeding arteries) was investigated using multivariable backward logistic regression.

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Section: Discussionsupporting

confidence: 47%

The Influence of Angioarchitectural Features on the Success of Endovascular Embolization of Cranial Dural Arteriovenous Fistulas with Onyx

Vollherbst¹,

Herweh²,

Schönenberger

et al. 2019

AJNR Am J Neuroradiol

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“…This can be explained by the high number of complex DAVFs in our cohort, with almost 75% of the patients having a CVR. In our study, 42% of the patients exhibited CVR with venous ectasia, as opposed to the studies of Rangel-Castilla et al [22] and Johnson et al [20], in which this subgroup comprised 14 and 22%, respectively. Tentorial DAVFs, in particular, more often required multiple treatment sessions in our study, which may have been due to the extensive arterial supply and the location [23].…”

Section: Discussioncontrasting

confidence: 95%

“…The use of such nonadhesive agents is nowadays well-established, with promising rates of CO. A recent study by Moenninghoff et al [16] demonstrated a CO rate of 77% in patients exclusively treated with Onyx. Another recent multicenter study revealed a CO rate of 92% for different nonadhesive liquids [20]. This is in agreement with our experience for all patients treated exclusively with EVOH.…”

Section: Discussionsupporting

confidence: 92%

Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

Maus

Drescher

Goertz

et al. 2020

Cerebrovasc Dis Extra

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Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.

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“…Onyx is widely used in TAE for its strong ability in penetrating the shunt and occluding the draining vein 22 . However, for the embolization of petroclival region DAVFs, Onyx is associated with higher risk of complications, because the Onyx would partially reflux during pushing forward 58 , 59 . In contrast, NBCA tends to move forward during TAE and does not reflux 10 , 45 , 46 .…”

Section: Transarterial Embolizationmentioning

confidence: 99%

Endovascular treatment for dural arteriovenous fistulas in the petroclival region

Hou¹,

Lv²,

Qu³

et al. 2020

Int. J. Med. Sci.

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Petroclival region dural arteriovenous fistulas (DAVFs) are rare and difficult lesions to manage. They often have very complex anatomical structures and can be further divided into the superior petrosal sinus, petrous apex, inferior petrosal sinus, upper clival, and upper clival epidural-osseous DAVFs. Most petroclival region DAVFs should be treated due to their high Cognard grades. Currently, endovascular treatment (EVT) has become the first-line therapeutic option for petroclival region DAVFs. But not all the petroclival region DAVFs could be cured with EVT. When the arterial feeders are large or the DAVF is adjacent to the venous sinus, the success rate may be higher. In petroclival region DAVFs, if EVT can be performed successfully, satisfactory outcome can be anticipated. However, there are some inadvertent complications, which include cranial nerve palsy, subsequent sinus thrombosis, and migration embolization of the internal carotid artery and vertebral artery. Currently, a review of the EVT of petroclival region DAVFs is lacking. In this article, we performed a review of the relevant literature on this issue. In addition, some illustrative cases would be provided to elaborate these specific entities.

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Embolization of cranial dural arteriovenous fistulas in the liquid embolic era: A Sydney experience

Cited by 8 publications

References 23 publications

The Influence of Angioarchitectural Features on the Success of Endovascular Embolization of Cranial Dural Arteriovenous Fistulas with Onyx

The Influence of Angioarchitectural Features on the Success of Endovascular Embolization of Cranial Dural Arteriovenous Fistulas with Onyx

Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A German Single-Center Experience

Endovascular treatment for dural arteriovenous fistulas in the petroclival region

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