The VEBAS score: A practical scoring system for intracranial dural arteriovenous fistula obliteration

Andrea Becerril-Gaitan, Dale Ding, Natasha Ironside, Thomas J. Buell, Akash P. Kansagra, Giuseppe Lanzino, Waleed Brinjikji, Louis Kim, Michael R. Levitt, Isaac Josh Abecassis, Diederik Bulters, Andrew Durnford, W. Christopher Fox, Spiros Blackburn, Peng Roc Chen, Adam J. Polifka, Dimitri Laurent, Bradley Gross, Minako Hayakawa, Colin DerdeynSepideh Amin-Hanjani, Ali Alaraj, J. Marc C. Van Dijk, Adriaan R.E. Potgieser, Robert M. Starke, Eric C. Peterson, Junichiro Satomi, Yoshiteru Tada, Adib A. Abla, Ethan A. Winkler, Rose Du, Pui Man Rosalind Lai, Gregory J. Zipfel, Ching Jen Chen, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Tools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes. Methods: Patients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC. Results: A total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27-1.48)) with each additional point in the overall patient score (range 0-12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0-3 score to 72-89% for patients scoring ≥8. Conclusion: The VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.

Original languageEnglish
Article numberjnis-2023-020282
JournalJournal of NeuroInterventional Surgery
DOIs
StateAccepted/In press - 2023

Keywords

  • Fistula
  • Hemorrhage
  • Intervention
  • Stroke

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