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

R.V. Chandra; T.M. Leslie-Mazwi; B.P. Mehta; A.J. Yoo; J.D. Rabinov; J.C. Pryor; J.A. Hirsch; R.G. Nogueira

doi:10.3174/ajnr.A3938

Research ArticleInterventional

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

R.V. Chandra, T.M. Leslie-Mazwi, B.P. Mehta, A.J. Yoo, J.D. Rabinov, J.C. Pryor, J.A. Hirsch and R.G. Nogueira

American Journal of Neuroradiology September 2014, 35 (9) 1793-1797; DOI: https://doi.org/10.3174/ajnr.A3938

R.V. Chandra

aFrom the Neuroradiology and Neurovascular Surgery Services, Departments of Diagnostic Imaging and Surgery (R.V.C.), Monash University, Melbourne, Victoria, Australia

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T.M. Leslie-Mazwi

bNeuroendovascular Service (T.M.L.-M., B.P.M., A.J.Y., J.D.R., J.A.H.)cDepartment of Neurology (T.M.L.-M., B.P.M.)

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B.P. Mehta

bNeuroendovascular Service (T.M.L.-M., B.P.M., A.J.Y., J.D.R., J.A.H.)cDepartment of Neurology (T.M.L.-M., B.P.M.)

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A.J. Yoo

bNeuroendovascular Service (T.M.L.-M., B.P.M., A.J.Y., J.D.R., J.A.H.)dDepartment of Radiology (A.J.Y., J.D.R., J.A.H.), Division of Diagnostic Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

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J.D. Rabinov

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J.C. Pryor

eDepartment of Interventional Neuroradiology (J.C.P.), Boston University, Boston, Massachusetts

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J.A. Hirsch

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R.G. Nogueira

fNeuroendovascular and Neurocritical Care Services and Neurology, Neurosurgery, and Radiology (R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.

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Table 1:

Baseline characteristics of study cohort (n = 40 patients with 41 cDAVFs)

Characteristic	No. of Patients
Age (mean; range)	57 (30–79)
Male (%)	21 (53%)
Presentation
Tinnitus	14 (35%)
Hemorrhage	13 (33%)
Incidental/nonspecific headache syndrome	10 (25%)
Seizure	2 (5%)
Superficial siderosis	1 (2%)
Cognard grade
I	5 (12%)
IIA	3 (7%)
IIB	3 (7%)
IIA+B	4 (10%)
III	15 (37%)
IV	11 (27%)
Borden grade
I	8 (15%)
II	7 (22%)
III	26 (63%)

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Table 2:

Procedural characteristics of study cohort (n = 41 DAVFs)

Characteristic	No.
No. of feeding pedicles (mean, range)	4 (1–10)
Total No. of embolization procedures	49
No. of embolization procedures per patient (mean; range)	1.2 (1–3)
No. of single-stage embolizations	35 (85%)
Complications (n = 49 embolization procedures)
Technical events	5 (10%)
All clinical events	7 (14%)
Transient neurologic	1 (2%)
Permanent neurologic	1 (2%)
Death	0

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Table 3:
Procedural effectiveness at time of treatment, short- and long-term follow-up
Procedural Effectiveness (No. of patients) Angiographic Cure (No.)
At end of final treatment (40) 35 (95%)
Short-term angiographic follow-up^{^a} (35) 33 (94%)
Long-term angiographic follow-up^{^b} (24) 24 (100%)
↵a Short-term follow-up occurred at a median of 4.2 months (2–12 months).
↵b Long-term angiographic follow-up occurred at a median of 28.2 months (12–63 months).

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

R.V. Chandra, T.M. Leslie-Mazwi, B.P. Mehta, A.J. Yoo, J.D. Rabinov, J.C. Pryor, J.A. Hirsch, R.G. Nogueira

American Journal of Neuroradiology Sep 2014, 35 (9) 1793-1797; DOI: 10.3174/ajnr.A3938

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

R.V. Chandra, T.M. Leslie-Mazwi, B.P. Mehta, A.J. Yoo, J.D. Rabinov, J.C. Pryor, J.A. Hirsch, R.G. Nogueira

American Journal of Neuroradiology Sep 2014, 35 (9) 1793-1797; DOI: 10.3174/ajnr.A3938

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Procedural Effectiveness (No. of patients)	Angiographic Cure (No.)
At end of final treatment (40)	35 (95%)
Short-term angiographic follow-up^{^a} (35)	33 (94%)
Long-term angiographic follow-up^{^b} (24)	24 (100%)