scholarly journals Pial Artery Supply as an Anatomic Risk Factor for Ischemic Stroke in the Treatment of Intracranial Dural Arteriovenous Fistulas

2017 ◽  
Vol 38 (12) ◽  
pp. 2315-2320 ◽  
Author(s):  
S.W. Hetts ◽  
A. Yen ◽  
D.L. Cooke ◽  
J. Nelson ◽  
P. Jolivalt ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Arteriovenous Fistulas ◽  
Pial Artery ◽  
Dural Arteriovenous Fistulas

Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)

2021 ◽  
pp. 1-9
Author(s):  
Isaac Josh Abecassis ◽  
R. Michael Meyer ◽  
Michael R. Levitt ◽  
Jason P. Sheehan ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Risk Factors For Recurrence ◽  
Cortical Venous Drainage

OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases). RESULTS Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision). CONCLUSIONS Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

scholarly journals Ischemic Stroke in Patients With Intracranial Dural Arteriovenous Fistulas

2011 ◽  
Vol 110 (5) ◽  
pp. 299-305 ◽  
Author(s):  
Shin-Joe Yeh ◽  
Li-Kai Tsai ◽  
Hon-Man Liu ◽  
Ping-Keung Yip ◽  
Jiann-Shing Jeng
Keyword(s):  
Ischemic Stroke ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

Clinical, angiographic, and treatment characteristics of cranial dural arteriovenous fistulas with pial arterial supply

2020 ◽  
pp. neurintsurg-2020-016374
Author(s):  
Waleed Brinjikji ◽  
Harry J Cloft ◽  
Giuseppe Lanzino
Keyword(s):  
Retrospective Study ◽  
Gamma Knife ◽  
Major Complication ◽  
Arterial Supply ◽  
Complication Rates ◽  
Arteriovenous Fistulas ◽  
Pial Artery ◽  
Treatment Characteristics ◽  
Dural Arteriovenous Fistulas

BackgroundThe prevalence of pial arterial supply to cranial dural arteriovenous fistulas (dAVF) and its implication in the management of these fistulas is not well characterized. We performed a retrospective study to characterize pial arterial supply to dural arteriovenous fistulas and the implications for treatment.MethodsConsecutive patients evaluated over a 12-year period were retrospectively reviewed. Angiograms were reviewed to characterize dAVF angioarchitecture and the presence of pial artery supply. Pial artery supply was categorized as dilated pre-existing dural branches and pure pial supply. We then studied the association between pial artery supply and clinical, angiographic, and treatment features.ResultsA total of 201 patients were included of which 27 (13.4%) had pial artery supply. Of these, 11 had supply from dilated pre-existing dural branches, nine had pure pial supply,and seven had both. There was a higher rate of dAVF rupture in the pial supply group (30.8% vs 9.8%, P=0.003) and these fistulas had a higher rate of Borden 2 and 3 (88.9% vs 38.4%, P<0.0001). Fistulas with pial artery supply had similar rates of endovascular and gamma knife treatment, but were more likely to undergo surgery than those without pial supply (25.9% vs 10.4%, P=0.03). Major complication rates were similar between groups (0% vs 1.1%, P=0.55).ConclusionsMore than 10% of dAVFs also have pial supply but this is not a contraindication to embolization. In our study pure pial supply was associated with a more aggressive fistula and was most common in tentorial dAVFs.

Surgical Management of Transosseous Dural Arteriovenous Fistulas in the Region of the Jugular Foramen

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Wuttipong Tirakotai ◽  
C. Kappus ◽  
B. Krischek ◽  
U. Sure ◽  
H. Bertalanffy
Keyword(s):  
Surgical Management ◽  
Jugular Foramen ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

Risk factor profile associated with major ischemic stroke subtypes in patients managed in a comprehensive stroke unit

2020 ◽  
Vol 0 (3) ◽  
pp. 7-14
Author(s):  
Y. V. Flomin ◽  
G. S. Trepet ◽  
V. G. Gurianov ◽  
L. I. Sokolova
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Stroke Unit ◽  
Risk Factor Profile ◽  
Stroke Subtypes

Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 21-27 ◽  
Author(s):  
Hyun Ho Jung ◽  
Jong Hee Chang ◽  
Kum Whang ◽  
Jin Soo Pyen ◽  
Jin Woo Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Gamma Knife Surgery ◽  
Low Flow ◽  
Close Monitoring ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

Sign in / Sign up

Export Citation Format

Share Document