RT Journal Article
SR Electronic
T1 Transarterial Treatment of Cranial Dural Arteriovenous Fistulas: The Role of Transarterial and Transvenous Balloon-Assisted Embolization
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 2100
OP 2106
DO 10.3174/ajnr.A6777
VO 41
IS 11
A1 J.O. Zamponi, Jr
A1 F.P. Trivelato
A1 M.T.S. Rezende
A1 R.K. Freitas
A1 L.H. de Castro-Afonso
A1 G.S. Nakiri
A1 T.G. Abud
A1 A.C. Ulhôa
A1 D.G. Abud
YR 2020
UL http://www.ajnr.org/content/41/11/2100.abstract
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