Citations 12
Outcome Following Hemorrhage From Cranial Dural Arteriovenous Fistulae
Koch, Matthew J. , Stapleton, Christopher J. , Guniganti, Ridhima , Lanzino, Giuseppe , Sheehan, Jason P. , Alaraj, Ali , Bulters, Diederik , Kim, Louis J. , Fox, W. Christopher , Gross, Bradley A. , Hayakawa, M. , Dijk, J. Marc C. van , Starke, Robert M., Satomi, Junichiro, Polifka, Adam , Zipfel, Gregory J. , Amin‐Hanjani, Sepideh , Derdeyn, Colin P. , Sheehan, Jason , Kim, Louis J. , van DijK, J Marc C , Amin-Hanjani, Sepideh , Alaraj, Ali , Fox, W Christopher , Lanzino, Giuseppe , Bulters, Diederik O , Derdeyn, Colin P , Gross, Bradley
Stroke | August 26, 2021 | Volume: 52 | Issue: 10 | Pages: No page available
Background and Purpose: Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–related hemorrhage. Methods: A retrospective review of patients in CONDOR who presented with dural arteriovenous fistula–related hemorrhage was performed. Patient characteristics, clinical follow-up, and radiographic details were analyzed for associations with poor outcome (defined as modified Rankin Scale score ≥3). Results: The CONDOR dataset yielded 262 patients with incident hemorrhage, with median follow-up of 1.4 years. Poor outcome was observed in 17.0% (95% CI, 12.3%–21.7%) at follow-up, including a 3.6% (95% CI, 1.3%–6.0%) mortality. Age and anticoagulant use were associated with poor outcome on multivariable analysis (odds ratio, 1.04, odds ratio, 5.1 respectively). Subtype of hemorrhage and venous shunting pattern of the lesion did not affect outcome significantly. Conclusions: Within the CONDOR registry, dural arteriovenous fistula–related hemorrhage was associated with a relatively lower morbidity and mortality than published outcomes from other arterialized cerebrovascular lesions but still at clinically consequential rates.
Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas
Buell, Thomas J. , Ding, Dale , Guniganti, Ridhima , Kansagra, Akash P. , Brinjikji, Waleed , Kim, Louis J. , Levitt, Michael R. , Abecassis, Isaac Josh, Bulters, Diederik , Durnford, Andrew , Fox, W. Christopher , Polifka, Adam , Gross, Bradley A. , Hayakawa, M. , Derdeyn, Colin P. , Amin‐Hanjani, Sepideh , Alaraj, Ali , Kwasnicki, Amanda , Dijk, J. Marc C. van , Potgieser, Adriaan R. E., Starke, Robert M., Satomi, Junichiro, Tada, Yoshiteru , Abla, Adib A. , Lai, Rosalind, Zipfel, Gregory J. , Sheehan, Jason P. , Piccirillo, Jay F. , Vine, Roanna , Cloft, Harry J. , Kallmes, David F. , Pollock, Bruce E. , Link, Michael J., Rao, Mohana Patibandla, Paisan, Gabriella, Meyer, R. Michael, Kelly, Cory , Duffill, Jonathan, Ditchfield, Adam, Millar, John S. , Macdonald, Jason, Laurent, Dimitri , Lockerman, Ashley, Lunsford, L. Dade , Jankowitz, Brian T. , Guerrero, Waldo R. , McGruder, Allen, Charbel, Fady T. , Aletich, Victor , Rose‐Finnell, Linda, Peterson, Eric C. , Yavagal, Dileep R. , Samir, Sur, Kanematsu, Yasuhisa , Kinouchi, T. , Korai, Masaaki , Yamaguchi, Izumi , Yamamoto, Yuki , Winkler, Ethan A. , Lawton, Michael T. , Rutkowski, Martin J. , Sultan, M. Ali Aziz, Patel, Nirav J. , Frerichs, Kai U., Ding, Dale , Amin-Hanjani, Sepideh , Alaraj, Ali , Du, Rose , Levitt, Michael R , Fox, W Christopher , van DijK, J Marc C , Abla, Adib , Bulters, Diederik O , Derdeyn, Colin P , Chen, Ching‐Jen , Lanzino, Giuseppe , Kim, Louis J. , Gross, Bradley , Samaniego, Edgar A , Chen, Stephanie , Phelps, Ryan , Raman, Hari S. , Lipsey, Kim L. , Giordan, Enrico , Link, Michael J. , Hoh, Brian L. , Smith, Jessica , Ortega-Gutierrez, Santiago , Hasan, David , Roa, Jorge A. , Rossen, James D. , Yamamoto, Nobuaki
Neurosurgery | January 14, 2021 | Volume: 88 | Issue: 6 | Pages: 1111-1120
Abstract BACKGROUND Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial. OBJECTIVE To compare the outcomes of observation versus intervention for low-grade dAVFs. METHODS We retrospectively reviewed dAVF patients from institutions participating in the CONsortium for Dural arteriovenous fistula Outcomes Research (CONDOR). Patients with low-grade (Borden type I) dAVFs were included and categorized into intervention or observation cohorts. The intervention and observation cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was modified Rankin Scale (mRS) at final follow-up. Secondary outcomes were excellent (mRS 0-1) and good (mRS 0-2) outcomes, symptomatic improvement, mortality, and obliteration at final follow-up. RESULTS The intervention and observation cohorts comprised 230 and 125 patients, respectively. We found no differences in primary or secondary outcomes between the 2 unmatched cohorts at last follow-up (mean duration 36 mo), except obliteration rate was higher in the intervention cohort (78.5% vs 24.1%, P < .001). The matched intervention and observation cohorts each comprised 78 patients. We also found no differences in primary or secondary outcomes between the matched cohorts except obliteration was also more likely in the matched intervention cohort ( P < .001). Procedural complication rates in the unmatched and matched intervention cohorts were 15.4% and 19.2%, respectively. CONCLUSION Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.