Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Curative transvenous embolization for congenital multi-hole pial arteriovenous fistula

  • Lane Fry (The University of Kansas School of Medicine) ;
  • Aaron Brake (The University of Kansas School of Medicine) ;
  • Catherine Lei (The University of Kansas School of Medicine) ;
  • Frank A. De Stefano (Department of Neurological Surgery, University of Kansas) ;
  • Adip G. Bhargav (Department of Neurological Surgery, University of Kansas) ;
  • Jeremy Peterson (Department of Neurological Surgery, University of Kansas) ;
  • Koji Ebersole (Department of Neurological Surgery, University of Kansas)
  • Received : 2022.07.21
  • Accepted : 2023.04.13
  • Published : 2024.03.31
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Abstract

Objective: Congenital intracranial pial arteriovenous fistula (PAVF) is a rare cerebral vascular pathology characterized by a direct shunt between one or more pial feeding arteries and a cortical draining vein. Transarterial endovascular embolization (TAE) is widely considered first line therapy. Curative TAE may not be achievable in the multi-hole variant due to the potential to harbor innumerable small feeding arteries. Transvenous embolization (TVE) may be considered to target the final common outlet of the lesion. Here, we present a series of four patients with complex multi-hole congenital PAVF treated with staged TAE followed by TVE. Methods: A retrospective review was conducted on patients who underwent treatment for congenital, multi-hole PAVFs treated by a combined TAE/TVE approach at our institution since 2013. Results: We identified four patients with multi-hole PAVF treated by a combined TAE/TVE. Median age was 5.2 (0-14.7) years. Median follow-up of 8 (1-15) months by catheter angiography and 38 (23-53) months by MRI/MRA was obtained. TVE achieved complete occlusion in three patients that proved durable on radiographic follow-up and demonstrated excellent clinical outcomes with a modified Rankin Score (mRS) of 0 or 1. Complete occlusion of the draining vein was not achieved by TVE in one case. This patient is graded as pediatric mRS=5 three years post-procedure. Conclusions: With thorough technical considerations, our series indicates that TVE of multi-hole PAVF that are refractory to TAE is feasible and effective in arresting the consequences of chronic, high-flow AV shunting produced by this pathology.

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References

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