@article{3557394bfef847c2a4b7a592d2195b24,
title = "Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)",
abstract = "OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases). RESULTS Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated presensurgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision). CONCLUSIONS Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.",
keywords = "dural arteriovenous fistula, re-treatment, recurrence, vascular disorders",
author = "{the Consortium for Dural Arteriovenous Fistula Outcomes Research} and Abecassis, {Isaac Josh} and Meyer, {R. Michael} and Levitt, {Michael R.} and Sheehan, {Jason P.} and Chen, {Ching Jen} and Gross, {Bradley A.} and Jessica Smith and Fox, {W. Christopher} and Enrico Giordan and Giuseppe Lanzino and Starke, {Robert M.} and Samir Sur and Potgieser, {Adriaan R.E.} and {van Dijk}, {J. Marc} and Andrew Durnford and Diederik Bulters and Junichiro Satomi and Yoshiteru Tada and Amanda Kwasnicki and Sepideh Amin-Hanjani and Ali Alaraj and Samaniego, {Edgar A.} and Minako Hayakawa and Derdeyn, {Colin P.} and Ethan Winkler and Adib Abla and Lai, {Pui Man Rosalind} and Rose Du and Ridhima Guniganti and Kansagra, {Akash P.} and Zipfel, {Gregory J.} and Kim, {Louis J.} and Piccirillo, {Jay F.} and Hari Raman and Kim Lipsey and Waleed Brinjikji and Roanna Vine and Cloft, {Harry J.} and Kallmes, {David F.} and Pollock, {Bruce E.} and Link, {Michael J.} and Patibandla, {Mohana Rao} and Dale Ding and Thomas Buell and Gabriella Paisan and Cory Kelly and Jonathan Duffill and Adam Ditchfield and John Millar and Jason Macdonald and Polifka, {Adam J.} and Dimitri Laurent and Brian Hoh and Ashley Lockerman and Lunsford, {L. Dade} and Jankowitz, {Brian T.} and Gutierrez, {Santiago Ortega} and David Hasan and Roa, {Jorge A.} and James Rossen and Waldo Guerrero and Allen McGruder and Charbel, {Fady T.} and Aletich, {Victor A.} and Linda Rose-Finnell and Peterson, {Eric C.} and Yavagal, {Dileep R.} and Chen, {Stephanie H.} and Yasuhisa Kanematsu and Nobuaki Yamamoto and Tomoya Kinouchi and Masaaki Korai and Izumi Yamaguchi and Yuki Yamamoto and Phelps, {Ryan R.L.} and Michael Lawton and Martin Rutkowski and Aziz-Sultan, {M. Ali} and Nirav Patel and Frerichs, {Kai U.}",
note = "Funding Information: reports non–study-related funding support from the NINDS, NIH, AHA, Stryker, Medtronic, and Philips Volcano; consultant fees from Medtronic; equity interest in Synchron, Cerebrotech, and eLoupes; and is an advisor for Metis Innovative. Dr. Alaraj reports funding support from the NIH, and consultant fees from Cerenovus and Siemens. Dr. Starke reports funding support from NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and the NIH; and consultant fees from Penumbra, Abbott, Medtronic, and Cerenovus. Dr. Gross reports consultant fees from MicroVention and Medtronic. Dr. Samaniego reports serving as a proctor with MicroVention. Publisher Copyright: {\textcopyright} AANS 2022",
year = "2022",
month = apr,
doi = "10.3171/2021.1.JNS202033",
language = "English",
volume = "136",
pages = "981--989",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
number = "4",
}