Transarterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas: Long-Term Follow-Up

Chandra, Ronil V.; Leslie‐Mazwi, Thabele M; Mehta, Brijesh; Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A; Nogueira, Raul G

doi:10.3174/ajnr.a3938

Cited by 56 publications

(32 citation statements)

References 22 publications

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“…We reserve the term "cure" to refer specifically to dAVFs with radiographic evidence of persistent vein/fistula casting and persistent angiographic occlusion at least 4 months after treatment on formal complete angiographic evaluation. As Chandra et al 9 reported, although short-term recurrence may occur (6% of cases in their series), long-term digital subtraction angiography following short-term digital subtraction angiography revealing occlusion consistently demonstrated durable obliteration (median follow-up 28 months). In contrast to some series, 25,26 we specifically evaluated the initial angiographic occlusion rate.…”

Section: 28mentioning

confidence: 60%

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Gross¹,

Albuquerque²,

Moon³

et al. 2016

JNS

110

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OBJECTIVEMany small series and technical reports chronicle the evolution of endovascular techniques for cranial dural arteriovenous fistulas (dAVFs) over the past 3 decades, but reports of large patient series are lacking. The authors provide a thorough analysis of clinical and angiographic outcomes across a large patient cohort.METHODSThe authors reviewed their endovascular database from January 1996 to September 2015 to identify patients harboring cranial dAVFs who were treated initially with endovascular approaches. They extracted demographic, presentation, angiographic, detailed treatment, and long-term follow-up data, and they evaluated natural history, initial angiographic occlusion, complications, recurrence, and symptomatic resolution rates.RESULTSAcross a cohort of 251 patients with 260 distinct dAVFs, the overall initial angiographic occlusion rate was 70%; recurrence or occult residual lesions were seen on subsequent angiography in 3% of cases. The overall complication rate was 8%, with permanent neurological complications occurring in 3% of cases. Among 102 patients with dAVFs without cortical venous reflux, rates of resolution/improvement of pulsatile tinnitus and ocular symptoms were 79% and 78%, respectively. Following the introduction of Onyx during the latter half of the study period, the number of treated dAVFs doubled; the initial angiographic occlusion rate increased significantly from 60% before the use of Onyx to 76% after (p = 0.01). In addition, during the latter period compared with the pre-Onyx period, the rate of dAVFs obliterated via a transarterial-only approach was significantly greater (43% vs 23%, p = 0.002), as was the number of dAVFs obliterated via a single arterial pedicle (29% vs 11%, p = 0.002).CONCLUSIONSOverall, in the Onyx era, the rate of initial angiographic occlusion was approximately 80%, as was the rate of meaningful clinical improvement in tinnitus and/or ocular symptoms after initial endovascular treatment of cranial dAVFs.

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Section: 28mentioning

confidence: 60%

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Gross¹,

Albuquerque²,

Moon³

et al. 2016

JNS

110

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“…Nevertheless, regardless of the formulation, Onyx ® completely solidifies within five minutes of injection[67]. Onyx ® forms a permanent occlusion, which has been shown to be stable for up to 5.25 years [68]. After being initially approved for use in AVM and intracranial aneurysms, Onyx ® has been used to effectively treat peripheral arteriovenous malformations [69], acute hemorrhages in the cardiopulmonary and gastrointestinal systems [70], preoperative embolization of vascular tumors [71], bleeding from ruptured aneurysms [72], and stent graft-related endoleaks [73–75].…”

Section: Commercially Available Materialsmentioning

confidence: 99%

Polymeric materials for embolic and chemoembolic applications

Poursaid

Jensen

Huo

et al. 2016

Journal of Controlled Release

111

103

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Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.

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“…If concern for persistent fistula exists, we repeat DSA at 1 month in addition to the above time points. This imaging approach is based on our historical approach to DAVF patients [15]. Given the prominent cognitive symptoms seen in these patients, we pursue formal neuropsychiatric testing and aggressive cognitive rehabilitation to optimize outcomes in this unusual population.…”

Section: Discussionmentioning

confidence: 99%

Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae

Colorado¹,

Matiello²,

Yang³

et al. 2018

Intervent Neurol

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Intracranial dural arteriovenous fistulae (DAVF) within the deep cerebral vasculature are diagnostically challenging because of their variable clinical presentation and typical bilateral neuroimaging findings mimicking inflammatory, infectious, and metabolic processes. Increasingly, reports have emerged highlighting the diagnostic and treatment challenges of these lesions and their associated high morbidity and rapid clinical deterioration when untreated. We describe here a case series of 4 patients with deep cerebral DAVF who presented with impaired arousal or memory and behavioral changes. In all patients, the initial differential diagnosis included metabolic, inflammatory, infectious, or neoplastic disease, with an eventual correct diagnosis obtained after catheter angiography had demonstrated arterialization of the deep venous structures, including the vein of Galen. All patients were successfully treated with endovascular embolization, with 1 patient requiring additional surgical treatment. We review the contemporary diagnostic evaluation and management of DAVF within the deep cerebral vasculature. With rapid diagnosis and treatment, a favorable outcome is possible.

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Transarterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas: Long-Term Follow-Up

Cited by 56 publications

References 22 publications

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Polymeric materials for embolic and chemoembolic applications

Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae

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