Outcomes After Onyx Embolization as Primary Treatment for Cranial Dural Arteriovenous Fistula in the Past Decade. 2020

Christoph Moenninghoff, and Ewelina Pohl, and Cornelius Deuschl, and Karsten Wrede, and Ramazan Jabbarli, and Alexander Radbruch, and Ulrich Sure, and Michael Forsting, and Isabel Wanke
Institute for diagnostic and interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Clinic for Neuroradiology, Clemenshospital Muenster, Muenster, Germany. Electronic address: c.moenninghoff@alexianer.de.

This retrospective single-center study aims to evaluate endovascular therapy (EVT) of cranial dural arteriovenous fistulas (dAVF) with ethylene vinyl alcohol (EVOH) copolymer (Onyx) regarding occlusion rates, complications, and recurrences. From January 2008 to April 2018, 75 patients with dAVF (41 men, 34 women; mean age 56 years) underwent EVT with the nonadhesive liquid embolic agent as primary treatment. Patient records and angiograms were reviewed for demographic data, symptoms, fistula type and size, number of EVTs, amount of embolic material, occlusion rates, and recurrences. Seventy-five patients with dAVFs were primarily embolized with EVOH in 96 EVTs. According to the Merland-Cognard classification the majority of dAVFs treated were type 4 (42.7%), followed by type 2a (18.7%), type 2a+b (17.3%), type 1 (8%), type 2b (5.3%), type 3 (5.3%), and type 5 (2.7%). Complete occlusion (CO) of the dAVF was achieved in 45/75 (60%) of cases after a single EVT and in 58 (77%) patients after one or several EVTs. Seven patients (9%) required additional surgical therapy for CO. Successful treatment was achieved for 70/75 (93%) patients including 10 (13%) patients with residual dAVFs type 1-2a. Recurrence after CO occurred in one (1.3%) patient and four (5.3%) patients remained refractory to therapy with dAVFs type > 2a. Procedure-related permanent morbidity occurred in 4/75 (5.3%) patients. For more than a decade transarterial EVOH embolization has established as the first-line treatment for cranial dAVFs with high cure rates and low rates of complications and recurrences. Additional neurosurgical therapy is rarely required for curative treatment.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011145 Polyvinyls POLYMERS derived from the monomer VINYL COMPOUNDS. Polyvinyl
D002533 Cerebral Angiography Radiography of the vascular system of the brain after injection of a contrast medium. Angiography, Cerebral,Angiographies, Cerebral,Cerebral Angiographies
D004621 Embolization, Therapeutic A method of hemostasis utilizing various agents such as Gelfoam, silastic, metal, glass, or plastic pellets, autologous clot, fat, and muscle as emboli. It has been used in the treatment of spinal cord and INTRACRANIAL ARTERIOVENOUS MALFORMATIONS, renal arteriovenous fistulas, gastrointestinal bleeding, epistaxis, hypersplenism, certain highly vascular tumors, traumatic rupture of blood vessels, and control of operative hemorrhage. Embolotherapy,Therapeutic Embolization,Embolizations, Therapeutic,Embolotherapies,Therapeutic Embolizations
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D020785 Central Nervous System Vascular Malformations Congenital, inherited, or acquired abnormalities involving ARTERIES; VEINS; or venous sinuses in the BRAIN; SPINAL CORD; and MENINGES. CNS Vascular Malformations,Congenital Vascular Malformations, Central Nervous System,Vascular Malformations, Brain,Vascular Malformations, Central Nervous System,Capillary Telangiectasia, Brain,Central Nervous System Congenital Vascular Malformations,Central Nervous System Vascular Anomalies,Cerebral Embryonic Artery, Persistent,Dural Arteriovenous Fistula,Embryonic Artery, Persistent, Cerebral,Persistent Cerebral Embryonic Artery,Pontine Capillary Telangiectasias,Vascular Anomalies, Central Nervous System,Vascular Malformations, Congenital, Nervous System,Arteriovenous Fistula, Dural,Arteriovenous Fistulas, Dural,Brain Capillary Telangiectasia,Brain Capillary Telangiectasias,Brain Vascular Malformation,Brain Vascular Malformations,CNS Vascular Malformation,Capillary Telangiectasia, Pontine,Capillary Telangiectasias, Brain,Capillary Telangiectasias, Pontine,Dural Arteriovenous Fistulas,Malformation, Brain Vascular,Malformation, CNS Vascular,Malformations, Brain Vascular,Malformations, CNS Vascular,Pontine Capillary Telangiectasia,Telangiectasia, Brain Capillary,Telangiectasia, Pontine Capillary,Telangiectasias, Brain Capillary,Telangiectasias, Pontine Capillary,Vascular Malformation, Brain,Vascular Malformation, CNS,Vascular Malformations, CNS

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