Long-term stability of Onyx: is there any indication for repeated angiography after dural arteriovenous fistula embolization?
Jazyk angličtina Země Spojené státy americké Médium electronic-print
Typ dokumentu časopisecké články
- Klíčová slova
- Onyx, arteriovenous fistula, embolization, interventional neurosurgery, recurrence, vascular disorders,
- MeSH
- cévní malformace centrálního nervového systému diagnostické zobrazování terapie MeSH
- digitální subtrakční angiografie MeSH
- dimethylsulfoxid * MeSH
- dospělí MeSH
- endovaskulární výkony MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční angiografie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mozková angiografie metody MeSH
- následné studie MeSH
- polyvinyly * MeSH
- prospektivní studie MeSH
- recidiva MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- terapeutická embolizace metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- dimethylsulfoxid * MeSH
- Onyx copolymer MeSH Prohlížeč
- polyvinyly * MeSH
OBJECTIVE: The natural course of dural arteriovenous fistulas (DAVFs) is unfavorable. Transarterial embolization with Onyx is currently the therapeutic method of choice, although the long-term stability of Onyx has been questioned. The literature reports a significant difference in the recurrence rate after complete DAVF occlusion and lacks larger series with long-term follow-up. The authors present the largest series to date with a long-term follow-up to determine the stability of Onyx, prospectively comparing magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as follow-up diagnostic methods. METHODS: Demographics, clinical symptomatology, length of follow-up, diagnostic methods, and angiographic findings of DAVFs were recorded and retrospectively evaluated in 112 patients. A prospective group of 15 patients with more than 5 years of follow-up after complete DAVF occlusion was established. All 15 patients in the prospective group underwent a clinical examination and MRA; 10 of these patients also underwent DSA. The recurrences and the correlation between the two diagnostic methods were evaluated. RESULTS: Among the 112 patients, 71 were men and 41 were women, with an average age of 60 years. Intracranial hemorrhage (40%) was the most common clinical presentation of DAVF. At the last follow-up, 73% of the patients experienced clinical improvement, 21% remained unchanged, and 6% worsened. Overall, 87.5% of the DAVFs were occluded entirely with endovascular treatment, and 93% of the DAVFs were classified as cured at the last follow-up (i.e., completely embolized DAVFs and DAVFs that thrombosed spontaneously or after Gamma Knife surgery). Two recurrences of DAVFs were recorded in the entire series. Both were first diagnosed by MRA and confirmed with DSA. The mean follow-up was 27.7 months. In the prospective group, a small asymptomatic recurrence was diagnosed. The mean follow-up of the prospective group was 96 months. CONCLUSIONS: Onyx is a stable embolic material, although recurrence of seemingly completely occluded DAVFs may develop because of postembolization hemodynamic changes that accentuate primarily graphically absent residual fistula. These residuals can be diagnosed with MRA at follow-up. The authors' data suggest that MRA could be sufficient as the follow-up diagnostic method after complete DAVF occlusion with Onyx. However, larger prospective studies on this topic are needed.
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