TY - JOUR
T1 - Recurrence after cure in cranial dural arteriovenous fistulas
T2 - a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)
AU - Abecassis, Isaac Josh
AU - Meyer, R Michael
AU - Levitt, Michael R
AU - Sheehan, Jason P
AU - Chen, Ching-Jen
AU - Gross, Bradley A
AU - Smith, Jessica
AU - Fox, W Christopher
AU - Giordan, Enrico
AU - Lanzino, Giuseppe
AU - Starke, Robert M
AU - Sur, Samir
AU - Potgieser, Adriaan R E
AU - van Dijk, J Marc C
AU - Durnford, Andrew
AU - Bulters, Diederik
AU - Satomi, Junichiro
AU - Tada, Yoshiteru
AU - Kwasnicki, Amanda
AU - Amin-Hanjani, Sepideh
AU - Alaraj, Ali
AU - Samaniego, Edgar A
AU - Hayakawa, Minako
AU - Derdeyn, Colin P
AU - Winkler, Ethan
AU - Abla, Adib
AU - Lai, Pui Man Rosalind
AU - Du, Rose
AU - Guniganti, Ridhima
AU - Kansagra, Akash P
AU - Zipfel, Gregory J
AU - Kim, Louis J
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - dural arteriovenous fistula
KW - recurrence
KW - re-treatment
KW - vascular disorders
KW - EMBOLIZATION
KW - ONYX
U2 - 10.3171/2021.1.JNS202033
DO - 10.3171/2021.1.JNS202033
M3 - Article
C2 - 34507283
SN - 0022-3085
VL - 136
SP - 981
EP - 989
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 4
ER -