PT  - JOURNAL ARTICLE
AU  - J.O. Zamponi, Jr
AU  - F.P. Trivelato
AU  - M.T.S. Rezende
AU  - R.K. Freitas
AU  - L.H. de Castro-Afonso
AU  - G.S. Nakiri
AU  - T.G. Abud
AU  - A.C. Ulhôa
AU  - D.G. Abud
TI  - Transarterial Treatment of Cranial Dural Arteriovenous Fistulas: The Role of Transarterial and Transvenous Balloon-Assisted Embolization
AID  - 10.3174/ajnr.A6777
DP  - 2020 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2100--2106
VI  - 41
IP  - 11
4099  - http://www.ajnr.org/content/41/11/2100.short
4100  - http://www.ajnr.org/content/41/11/2100.full
SO  - Am. J. Neuroradiol.2020 Nov 01; 41
AB  - BACKGROUND AND PURPOSE: Treatment of dural arteriovenous fistulas can be performed by transarterial or transvenous accesses. For those fistulas located at a dural sinus wall, obliteration of the sinus might lead to a substantial risk of complications if the occluded sinus impairs normal venous drainage. For those fistulas with direct leptomeningeal venous drainage, navigation to reach the arteriovenous shunting point of a leptomeningeal vein is usually technically demanding. We report the outcomes of patients with dural AVFs treated by transarterial injection of liquid embolic agents assisted by transarterial double-lumen balloon catheters and/or transvenous balloon catheters.MATERIALS AND METHODS: This was a retrospective, 3-center study including patients with dural AVFs treated with a balloon-assisted technique in at least 1 treatment session. Angiographic follow-up was performed at 6 months. Clinical assessment was performed at admission and discharge and was reassessed at 30-day and 6-month follow-ups.RESULTS: Forty-one patients with 43 dural AVFs were treated. Thirty-four fistulas were located at a dural sinus wall. Treatment was performed using only a transarterial approach in 42 fistulas. Only 1 session was needed for complete obliteration of the fistula in 86% of the patients. Immediate complete angiographic occlusion was achieved in 39 fistulas. Of the 41 controlled fistulas, 40 (97.6%) were completely occluded at 6 months. Thirty-nine fistulas (95.1%) were cured without any report of major neurologic events or death during follow-up.CONCLUSIONS: Transarterial balloon-assisted treatment of dural AVFs with or without transvenous balloon protection was shown to be safe and effective.DAVFdural arteriovenous fistulaDLBdouble-lumen balloonDLVDdirect leptomeningeal venous drainageMMAmiddle meningeal arteryNALEAnonadhesive liquid embolic agentOCCoccipital arteryTAAtransarterial approachTVAtransvenous approachTVBtransvenous balloon