Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
J Neurointerv Surg. 2018 Jul;10(7):e15. doi: 10.1136/neurintsurg-2017-013282.rep. Epub 2018 Mar 21.
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.
我们报告了一例颅内硬脑膜动静脉瘘（DAVF）在颅内静脉窦支架置入术（VSS）治疗特发性颅内高压患者后发生的病例。发病机制可能涉及支架置入后静脉窦压力增加引起的血流动力学改变，这可能导致新的动脉长入瘘管窦壁而没有毛细血管介入。尽管进行了双联抗血小板治疗，但也可能存在导致 DAVF 形成的亚临床皮质静脉血栓形成。除了上述机制外，VSS 引起的炎症增加可能上调血管内皮生长因子和血小板衍生生长因子的表达，并促进 DAVF 的发病机制。由于 VSS 已被用于闭塞 DAVFs，因此 VSS 后 DAVF 的形成似乎违反直觉。以前的支架通常是封闭细胞、不锈钢设计，用于最大限度地压缩瘘管窦壁的径向。相比之下，我们患者的支架是一种开放细胞、自扩张镍钛诺设计（Protégé Everflex）。神经介入医生应该意识到这种潜在的、尽管罕见的 VSS 后 DAVF 形成的并发症。
