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Abstract - Technical Note
| J Cerebrovasc Endovasc Neurosurg. 2024 26(1): 85-96 ¨Ï The Journal of Cerebrovascular and Endovascular Neurosurgery |
 
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| Curative transvenous embolization for congenital multi-hole pial arteriovenous fistula |
| Lane Fry1, Aaron Brake1, Catherine Lei1, Frank A. De Stefano2, Adip G. Bhargav2, Jeremy Peterson2, Koji Ebersole2 |
| 1The University of Kansas School of Medicine, Kansas City, Kansas, USA 2Department of Neurological Surgery, University of Kansas, Kansas City, Kansas, USA |
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| 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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| Key words : Pial atriovenous fistula, Transvenous embolization, Vascular malformation, Endovascular, Pediatric |
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