Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지
DOI QR코드

DOI QR Code

Spontaneous occlusion of a pial arteriovenous fistula after angiography: The role of iodinated contrast media

  • Seby John (Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic) ;
  • Tanmoy Kumar Maiti (Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic) ;
  • Praveen Kesav (Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic) ;
  • Ashna Arif (School of Medicine, Queen's University) ;
  • Syed Irteza Hussain (Department of Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic)
  • Received : 2022.12.13
  • Accepted : 2023.08.06
  • Published : 2024.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Intracranial non-galenic pial arteriovenous fistula (PAVF) is an extremely rare vascular malformation, where one or more pial arteries feeds directly into a cortical vein without any intervening nidus. Though occasionally they can be asymptomatic, neurological symptoms such as headache, seizure, or focal neurological deficit are more common presenting features. Life threatening or fatal hemorrhage is not uncommon, hence needed to be treated more often than not. Spontaneous occlusion of PAVF is reported only four times before. We report a 49-year-old gentleman, who was diagnosed to have a PAVF, possibly secondary to trauma. He presented 5 months and 22 days from initial digital subtraction angiography (DSA) for treatment, and follow-up angiogram showed complete obliteration. He denied any significant event, medication or alternate treatment during this period. His clinical symptoms were stable as well. We postulate iodinated contrast medium induced vasculopathy as a possible cause, which has been described for other vascular pathologies, but never for PAVF.

Keywords

References

  1. Chang CF, Liu XM, Peyton KJ, Durante W. Heme oxygenase-1 counteracts contrast media-induced endothelial cell dysfunction. Biochem Pharmacol. 2014 Jan;87(2):303-11.
  2. Franke RP, Fuhrmann R, Hiebl B, Jung F. Influence of radiographic contrast media (Iodixanol and Iomeprol) on the endothelin-1 release from human arterial and venous endothelial cells cultured on an extracellular matrix. Clin Hemorheol Microcirc. 2012;52(2-4):229-34.
  3. Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Dowd CF, Barnwell SL. Transarterial occlusion of solitary intracerebral arteriovenous fistulas. AJNR Am J Neuroradiol. 1989 Jul-Aug;10(4):747-52.
  4. Hoh BL, Putman CM, Budzik RF, Ogilvy CS. Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae. Neurosurgery. 2001 Dec;49(6):1351-63.
  5. John S, Hussain SI, Elhammady MS, Navarro R, Zahra K. Multiple cranial dural and pial arteriovenous fistulas with occlusion of all after embolization of primary superior sagittal sinus dural fistula. World Neurosurg. 2020 Aug;140:224-8.
  6. Lyons MK, Hoxworth JM, McClendon J, Krishna CX, Patel NP. Spontaneous resolution of ruptured intracranial pial arteriovenous fistula following spinal surgery. Neuroradiol J. 2017 Apr;30(2):175-9.
  7. Medhi G, Gupta AK, Saini J, Ramalingaiah AH, Pendharkar H, Parida S. Pial arteriovenous fistula: A clinical and neuro-interventional experience of outcomes in a rare entity. Indian Journal of Radiology and Imaging. 2020 JulSep;30(3):286-93.
  8. Peeters SM, Colby GP, Guivatchian E, Sun MZ, Tateshima S, Wang AC. Spontaneous resolution of dural and pial arteriovenous fistulae arising after superficial temporal artery to middle cerebral artery bypass for moyamoya disease. World Neurosurg. 2020 Oct;142:404-7.
  9. Ren L, Wang P, Wang Z, Liu Y, Lv S. Hypotonic contrast media is more toxic than isotonic contrast media on endothelial cells in vivo and in vitro. Mol Med Rep. 2017 Oct;16(4):4334-40.
  10. Ronda N, Poti F, Palmisano A, Gatti R, Orlandini G, Maggiore U, et al. Effects of the radiocontrast agent iodixanol on endothelial cell morphology and function. Vascul Pharmacol. 2013 Jan;58(1-2):39-47.
  11. Santosh C, Teasdale E, Molyneux A. Spontaneous closure of an intracranial middle cerebral arteriovenous fistula. Neuroradiology. 1991;33(1):65-6.
  12. Satow T, Suzuki M, Komuro T, Ogawa M, Kobayashi A, Nishida S. Spontaneous resolution of cerebral pial arteriovenous fistula after angiography: Report of two cases. World Neurosurg. 2017 Jul;103:954.e5-954.e10.
  13. Scoditti E, Massaro M, Montinari MR. Endothelial safety of radiological contrast media: Why being concerned. Vascul?Pharmacol. 2013 Jan;58(1-2):48-53.
  14. Zhang B, Zhang Y, Liu B, Fang L, Li Y, Meng S. Iso-osmolar iodixanol induces less increase in circulating endothelial microparticles in vivo and less endothelial apoptosis in vitro compared with low-osmolar iohexol. Contrast Media Mol Imaging. 2018 Apr;2018:8303609.
  15. Zhao Y, Tao Z, Xu Z, Tao Z, Chen B, Wang L, et al. Toxic effects of a high dose of non-ionic iodinated contrast media on renal glomerular and aortic endothelial cells in aged rats in vivo. Toxicol Lett. 2011 May;202(3):253-60.