Department of Neurology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.
J Formos Med Assoc. 2011 May;110(5):299-305. doi: 10.1016/S0929-6646(11)60045-4.
BACKGROUND/PURPOSE: Intracranial dural arteriovenous fistulas (DAVFs) can be complicated by ischemic stroke. This study investigated the frequency and determinants of ischemic stroke in patients with intracranial DAVF.
We conducted a retrospective study of consecutive patients with intracranial DAVF. Patients with pure hemorrhagic stroke or without available brain imaging for clarifying stroke type were excluded. DAVF was diagnosed by cerebral catheter angiography. Cognard classification and location of DAVFs were ascertained. The clinical characteristics, outcome, and radiographic findings were recorded. Factors associated with occurrence of ischemic stroke in the patients with DAVFs were determined.
A total of 134 patients were enrolled. Six patients (4.5%) had ischemic stroke (mean age: 53.8 ± 13.4 years) and 128 patients were free from stroke (mean age: 55.4 ± 15.2 years). Men accounted for 83% in the ischemic stroke group and 34% in the non-stroke group. Chemosis, exophthalmos and tinnitus were more frequent in the non-stroke group, whereas seizure and mental decline were more frequent in the ischemic stroke group. DAVF was associated with highest risk of ischemic stroke at locations other than the cavernous sinus or large sinuses. Ischemic stroke also correlated with types of DAVF involving cortical venous drainage, including type IIb (18%), III (15%), and IV (100%). No patient with DAVF type I and IIa had ischemic stroke. The rate of ischemic stroke in patients with concomitant DAVF and cerebral sinus thrombosis was higher than in DAVF patients without cerebral sinus thrombosis. Venous infarct was the major subtype of ischemic stroke in five DAVF patients. Endovascular therapy was the most common choice in both groups, and fewer patients in the ischemic stroke group did not receive any treatment for DAVFs.
Location and type of DAVF were two important factors related to the occurrence of ischemic stroke in DAVF patients.
背景/目的：颅内硬脑膜动静脉瘘（DAVF）可并发缺血性卒中。本研究旨在探讨颅内 DAVF 患者发生缺血性卒中的频率和决定因素。
我们对连续的颅内 DAVF 患者进行了回顾性研究。排除了单纯出血性卒中或无明确卒中类型的脑影像学检查的患者。通过脑导管血管造影术诊断 DAVF。确定 DAVF 的 Cognard 分类和位置。记录患者的临床特征、结局和影像学表现。确定与 DAVF 患者发生缺血性卒中相关的因素。
共纳入 134 例患者。6 例（4.5%）患者发生缺血性卒中（平均年龄：53.8 ± 13.4 岁），128 例患者无卒中（平均年龄：55.4 ± 15.2 岁）。缺血性卒中组中男性占 83%，非卒中组中男性占 34%。非卒中组中更常见眶周淤血、眼球突出和耳鸣，而缺血性卒中组中更常见癫痫发作和精神状态下降。DAVF 位于海绵窦或大窦以外的部位与发生缺血性卒中的风险最高相关。与涉及皮质静脉引流的 DAVF 类型（包括 IIb 型[18%]、III 型[15%]和 IV 型[100%]）也存在相关性。未发现 I 型和 IIa 型 DAVF 患者发生缺血性卒中。伴有 DAVF 和脑静脉窦血栓形成的患者发生缺血性卒中的发生率高于无脑静脉窦血栓形成的 DAVF 患者。静脉梗死是 5 例 DAVF 患者中缺血性卒中的主要亚型。血管内治疗是两组患者最常见的治疗选择，缺血性卒中组中较少的患者未接受任何 DAVF 治疗。
DAVF 的位置和类型是与 DAVF 患者发生缺血性卒中相关的两个重要因素。
