TY - JOUR
T1 - Dural Arteriovenous Fistulas With Cognitive Impairment
T2 - Angiographic Characteristics and Treatment Outcomes
AU - Sanchez, Sebastian
AU - Wendt, Linder
AU - Hayakawa, Minako
AU - Chen, Ching Jen
AU - Sheehan, Jason P.
AU - Kim, Louis J.
AU - Abecassis, Isaac Josh
AU - Levitt, Michael R.
AU - Meyer, R. Michael
AU - Guniganti, Ridhima
AU - Kansagra, Akash P.
AU - Lanzino, Giuseppe
AU - Giordan, Enrico
AU - Brinjikji, Waleed
AU - Bulters, Diederik O.
AU - Durnford, Andrew
AU - Fox, W. Christopher
AU - Smith, Jessica
AU - Polifka, Adam J.
AU - Gross, Bradley
AU - Amin-Hanjani, Sepideh
AU - Alaraj, Ali
AU - Kwasnicki, Amanda
AU - Starke, Robert M.
AU - Chen, Stephanie H.
AU - Van Dijk, J. Marc C.
AU - Potgieser, Adriaan R.E.
AU - Satomi, Junichiro
AU - Tada, Yoshiteru
AU - Phelps, Ryan
AU - Abla, Adib
AU - Winkler, Ethan
AU - Du, Rose
AU - Rosalind Lai, Pui Man
AU - Ortega-Gutierrez, Santiago
AU - Zipfel, Gregory J.
AU - Derdeyn, Colin
AU - Samaniego, Edgar A.
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Medknow Publications. All rights reserved.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - BACKGROUND AND OBJECTIVES: Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs. METHODS: Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed. RESULTS: A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P =.027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P <.001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P =.004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P =.024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P =.09) CONCLUSION: Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.
AB - BACKGROUND AND OBJECTIVES: Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs. METHODS: Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed. RESULTS: A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P =.027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P <.001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P =.004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P =.024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P =.09) CONCLUSION: Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.
KW - Dementia
KW - Fistula
KW - Intervention
UR - http://www.scopus.com/inward/record.url?scp=85199297049&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002802
DO - 10.1227/neu.0000000000002802
M3 - Article
C2 - 38095434
AN - SCOPUS:85199297049
SN - 0148-396X
VL - 94
SP - 1035
EP - 1043
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -