TY - JOUR
T1 - Risk of Early Versus Later Rebleeding from Dural Arteriovenous Fistulas with Cortical Venous Drainage
AU - Durnford, Andrew J.
AU - Akarca, Danyal
AU - Culliford, David
AU - Millar, John
AU - Guniganti, Ridhima
AU - Giordan, Enrico
AU - Brinjikji, Waleed
AU - Chen, Ching Jen
AU - Abecassis, Isaac Josh
AU - Levitt, Michael
AU - Polifka, Adam J.
AU - Derdeyn, Colin P.
AU - Samaniego, Edgar A.
AU - Kwasnicki, Amanda
AU - Alaraj, Ali
AU - Potgieser, Adriaan R.E.
AU - Chen, Stephanie
AU - Tada, Yoshiteru
AU - Phelps, Ryan
AU - Abla, Adib
AU - Satomi, Junichiro
AU - Starke, Robert M.
AU - Van Dijk, J. Marc C.
AU - Amin-Hanjani, Sepideh
AU - Hayakawa, Minako
AU - Gross, Bradley
AU - Fox, W. Christopher
AU - Kim, Louis
AU - Sheehan, Jason
AU - Lanzino, Giuseppe
AU - Kansagra, Akash P.
AU - Du, Rose
AU - Lai, Rosalind
AU - Zipfel, Gregory J.
AU - Bulters, Diederik O.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage. Methods: Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference. Results: Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026). Conclusions: The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.
AB - Background: Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage. Methods: Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference. Results: Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026). Conclusions: The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.
KW - drainage
KW - fistula
KW - hemorrhage
KW - incidence
KW - natural history
UR - http://www.scopus.com/inward/record.url?scp=85133103148&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.121.036450
DO - 10.1161/STROKEAHA.121.036450
M3 - Article
C2 - 35420453
AN - SCOPUS:85133103148
SN - 0039-2499
VL - 53
SP - 2340
EP - 2345
JO - Stroke
JF - Stroke
IS - 7
ER -