Transarterial embolization of sinusal dural arteriovenous fistula with transvenous balloon protection

Abstract

Objective To evaluate the safety and efficacy of transarterial embolization of dural arteriovenous malformation (DAVF) using transvenous Copernic RC balloon protection. Methods Fifteen patients with DAVF (6 from Departments of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University and 9 from Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University) embolized using transvenous balloon protection between March 2014 and November 2017 were included retrospectively. Fourteen patients had single fistula in which 11 were located at transverse-sigmoid sinus (TSS) and 3 were located at superior sagittal sinus (SSS). One patient had multiple fistulas located at SSS and tentorium. Two patients presented with Cognard type I fistula, 7 with Cognard type Ⅱa, 1 with Cognard type Ⅱb and 5 with Cognard type Ⅱa+ b. Ten patients were treated for the first time and 5 were re-treated. The clinical and angiographic data were collected and the cure rate, complications and clinical outcome were analyzed. Results In the 10 patients treated for the first time, complete occlusion was achieved in 8 patients, near-complete occlusion in 1 and partial occlusion in 1. In the 5 patients re-treated, complete occlusion was achieved in 1, near-complete occlusion in 2 and partial occlusion in 2. All the involved sinuses were patent after embolization. Three patients suffered from severe complications including 1 with epidural hemorrhage, 1 with cerebellar hemorrhage and 1 with cerebellar infarction. All patients were followed up for 5 to 48 months(median: 19 months). Seven patients′ symptoms disappeared at follow-up, 7 patients were improved including 2 with postinterventional hemorrhage. One patient with cerebellar infarction deteriorated. The angiography follow-up was achieved in 8 cases for 4 to 24 months(median: 7 months). There was no recurrence in 6 patients with complete occlusion. One patient with near-complete occlusion and 1 with partial occlusion were stable. Conclusions The transvenous balloon assisted technique seems helpful to preserve the patency of dural sinus and improve the occlusion rate during the embolization of DAVF. However, it might have risks of hemorrhage and infarction and should be used carefully. Key words: Arteriovenous fistula; Embolization, therapeutic; Dural; Transvenous balloon