Citations 2
Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage
Durnford, Andrew , Akarca, Danyal , Culliford, David , Millar, John S. , Guniganti, Ridhima , Giordan, Enrico , Brinjikji, Waleed , Chen, Ching‐Jen , Abecassis, Isaac Josh , Levitt, Michael R. , Polifka, Adam , Derdeyn, Colin P. , Kwasnicki, Amanda , Alaraj, Ali , Potgieser, Adriaan R. E., Tada, Yoshiteru , Abla, Adib A. , Satomi, Junichiro, Starke, Robert M., Dijk, J. Marc C. van , Amin‐Hanjani, Sepideh , Hayakawa, M. , Gross, Bradley A. , Kim, Louis J. , Sheehan, Jason P. , Kansagra, Akash P. , Lai, Rosalind, Zipfel, Gregory J. , Bulters, Diederik , Piccirillo, Jay F. , Vine, Roanna , Cloft, Harry J. , Kallmes, David F. , Pollock, Bruce E. , Link, Michael J. , Patibandla, Mohana Rao, Ding, Dale , Buell, Thomas J. , Paisan, Gabriella, Meyer, R. Michael, Kelly, Cory , Duffill, Jonathan, Ditchfield, Adam, 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. , Sur, Samir , 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 , Frerichs, Kai U., Levitt, Michael R , Polifka, Adam J , Samaniego, Edgar A , Alaraj, Ali , Tada, Yoshiteru , Phelps, Ryan , Abla, Adib , van DijK, J Marc C , Amin-Hanjani, Sepideh , Gross, Bradley , Fox, W Christopher , Kim, Louis J. , Sheehan, Jason , Lanzino, Giuseppe , Kansagra, Akash P , Du, Rose , Lai, Rosalind , Zipfel, Gregory J , Bulters, Diederik O , Ding, Dale , Chen, Ching-Jen , Derdeyn, Colin P , Abecassis, Isaac Josh , Millar, John, Chen, Stephanie , Lanzino, Giuseppe , Raman, Hari S. , Lipsey, Kim L. , Hoh, Brian L. , Smith, Jessica , Ortega-Gutierrez, Santiago , Hasan, David , Roa, Jorge A. , Rossen, James D. , Yamamoto, Nobuaki
Stroke | April 14, 2022 | Volume: 53 | Issue: 7 | Pages: 2340-2345
Background: Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage. Methods: Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference. Results: Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2–14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3–5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7–12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4–37.7; P , 0.026). Conclusions: The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.
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.