688 Stratified Assessment of Treatment Approach for Craniocervical Junction Arteriovenous Fistulas: A Multicenter Cohort and Pool Analysis

Abstract

INTRODUCTION: Cranio-cervical junction arteriovenous fistulas (CCJ-AVFs) are complex vascular shunts that present a challenge for treatment. METHODS: We conducted a retrospective analysis of 132 patients who underwent microsurgery or endovascular embolization for CCJ-AVF. The baseline characteristics, angioarchitectural features, and clinical outcomes were compared between the two treatment groups. A subgroup analysis was also performed in CCJ-AVF with carotid artery feeders. RESULTS: The complete obliteration rate was 97.1% in the microsurgery group, 85.3% in the embolization via carotid artery (CA) approach group, and 62.5% in the embolization via vertebral artery (VA) approach group. After adjusting for baseline and confounding features, the occlusion rate was significantly lower in embolization via VA approach (adjusted OR, 0.04; 95% CI, 0.005-0.40, p = 0.006). None of the patients in the microsurgical group appeared new-onset infarction, while 1 (2.9%) in CA embolization and 3 (12.5%) in VA embolization suffered new-onset infarction after treatment. The neurological improvement rate of microsurgery was similar to that of embolization via CA approach. Embolization via VA was associated with less neurological improvement (adjusted OR, 0.11; 95% CI, 0.03-0.38, p = 0.001). In the subgroup analysis of CCJ-AVF with CA feeders, the occlusion rate and neurological improvement of embolization via CA approach were comparable to those of microsurgery. CONCLUSIONS: Our study suggests that microsurgery and embolization via CA approach can achieve similar clinical outcomes for CCJ-AVF. Embolization via VA approach may result in a lower occlusion rate and less neurological improvement. In CCJ-AVF with CA feeders, embolization via CA approach may be a safe and effective alternative to microsurgery.