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Digital Subtraction Angiography‐Dynavision in Pretreatment Planning for Embolization of Dural Arterio‐Venous Fistulas

2017; Wiley; Volume: 28; Issue: 1 Linguagem: Inglês

10.1111/jon.12459

1552-6569

Alex Botsford, Jai Shankar,

Neurosurgical Procedures and Complications

ABSTRACT BACKGROUND AND PURPOSE We have found DSA‐Dynavision with multiplanar reconstruction very helpful in understanding the complex anatomy and planning of treatment of carotico‐cavernous fistulas. The purpose of our study was to examine whether using DSA‐Dynavision in pretreatment planning results in better outcome after endovascular treatment of dural arterio‐venous fistulas (dAVFs). METHODS Patients with dAVF treated with endovascular embolization were retrospectively identified from our interventional neuroradiology database. Patients were assessed and divided into those with DSA‐Dynavision and those without. They were compared for procedural time, angiographic evidence of cure, rates of resolution of cortical venous reflux (CVR), complications, and need for postembolization surgery. RESULTS Eighty‐six percent of 28 patients (mean age 57 years, range 1.67‐84 years) had Borden type 3 DAVF; 7% had Borden type 2; and 7% had Borden type 1. DSA‐Dynavision was used in 14 of 28 (50%) patients. Fewer patients with DSA‐Dynavision required postendovascular embolization surgery (7% vs. 50%, P = .01) and fewer DSA‐Dynavision patients had CVR postprocedure (29% vs. 71%, P = .023). Mean procedural time (207 vs. 249 minutes; P = .40); permanent neurological complication rates (7% vs. 7%, P = 1.0); rate of immediate angiographic occlusion (64% vs. 29%, P = .061), and reported resolution of symptoms (79% vs. 53%, P = .18) were not significantly different. There was no significant difference in follow‐up (mean: 75 vs 120 weeks, P = .47). CONCLUSION The use of DSA‐Dynavision in planning of endovascular treatment of dAVF is associated with higher rates of elimination of CVR and less need for postembolization surgery.