The Procedure-Related Complications of Transarterial Onyx Embolization of Dural Arteriovenous Fistula Using Transvenous Balloon Protection

Abstract

Transarterial embolizatioin with transvenous balloon protection has been described as a promising technique for intracranial dural arteriovenous fistula. The aim of our study was to report our preliminary experiences of this technique with regard to its safety and efficacy and to emphasize the procedure-related complications. Fourteen consecutive patients with dural arteriovenous fistula were treated with a transvenous balloon-assisted technique between March 2014 and November 2017. All lesions were embolized with Onyx via a transarterial approach with sinus balloon protection to preserve the patency of the dural sinus. Clinical and angiographic data were retrospectively collected and the occlusion rate, complications, and clinical outcome were analyzed. All 14 patients were symptomatic on admission, mean age was 40.9 years, and 9 (64.3%) of them were men. Thirteen patients had a single fistula at transverse-sigmoid sinus (n= 10) or superior sagittal sinus (n= 3), and another patient had multiple fistulas located at SSS/tentorium. Two patients presented with Cognard type I fistula, 12 with Cognard type II (IIa:6;IIb:1;IIa+ b:5). Complete (8/11) or near-complete (3/11) occlusion was achieved in 11 patients (78.6%). Procedure-related complications occurred in 3 cases, including 1 epidural hemorrhage, 1 cerebellar hemorrhage, and 1 cerebellar infarction. At latest clinical follow-up (mean: 13 months), symptoms were resolved on 6 patients, relieved in 7 patients, and deteriorated in 1 patient. The transvenous balloon protection offers an alternative to treat complex dural arteriovenous fistula, but further investigation are needed to lower related complications.