Digital Subtraction Angiography-Dynavision in Pretreatment Planning for Embolization of Dural Arterio-Venous Fistulas.

BACKGROUND AND PURPOSE: We have found DSA-Dynavision with multiplanar reconstruction very helpful in understanding the complex anatomy and planning of treatment of carotico-cavernous fistulas. The purpose of our study was to examine whether using DSA-Dynavision in pretreatment planning results in better outcome after endovascular treatment of dural arterio-venous fistulas (dAVFs).

METHODS: Patients with dAVF treated with endovascular embolization were retrospectively identified from our interventional neuroradiology database. Patients were assessed and divided into those with DSA-Dynavision and those without. They were compared for procedural time, angiographic evidence of cure, rates of resolution of cortical venous reflux (CVR), complications, and need for postembolization surgery.

RESULTS: Eighty-six percent of 28 patients (mean age 57 years, range 1.67-84 years) had Borden type 3 DAVF; 7% had Borden type 2; and 7% had Borden type 1. DSA-Dynavision was used in 14 of 28 (50%) patients. Fewer patients with DSA-Dynavision required postendovascular embolization surgery (7% vs. 50%, P = .01) and fewer DSA-Dynavision patients had CVR postprocedure (29% vs. 71%, P = .023). Mean procedural time (207 vs. 249 minutes; P = .40); permanent neurological complication rates (7% vs. 7%, P = 1.0); rate of immediate angiographic occlusion (64% vs. 29%, P = .061), and reported resolution of symptoms (79% vs. 53%, P = .18) were not significantly different. There was no significant difference in follow-up (mean: 75 vs 120 weeks, P = .47).

CONCLUSION: The use of DSA-Dynavision in planning of endovascular treatment of dAVF is associated with higher rates of elimination of CVR and less need for postembolization surgery.