Onyx 栓塞治疗颅部硬脑膜动静脉瘘血管构筑特征对治疗效果的影响
The Influence of Angioarchitectural Features on the Success of Endovascular Embolization of Cranial Dural Arteriovenous Fistulas with Onyx.
机构信息
From the Departments of Neuroradiology (D.F.V., C.H., F.S., M.B., M.A.M.).
Neurology (S.S., S.N., P.A.R.), Heidelberg University Hospital, Heidelberg, Germany.
出版信息
AJNR Am J Neuroradiol. 2019 Dec;40(12):2130-2136. doi: 10.3174/ajnr.A6326. Epub 2019 Nov 21.
BACKGROUND AND PURPOSE
Endovascular embolization can be an effective treatment for cranial dural arteriovenous fistulas. However, a considerable number of dural arteriovenous fistulas still cannot be treated sufficiently. The purpose of this study was to report our single-center experience of endovascular embolization of dural arteriovenous fistulas with Onyx, including the investigation of the influence of angioarchitectural features on the treatment success.
MATERIALS AND METHODS
Clinical data, angioarchitectural features, complications, treatment success (defined as complete symptom remission for low-grade dural arteriovenous fistulas and complete occlusion for high-grade dural arteriovenous fistulas), and occlusion rates were assessed. The influence of various angioarchitectural features (including location, pattern of venous drainage, and quantity and origin of feeding arteries) was investigated using multivariable backward logistic regression.
RESULTS
One hundred four patients with 110 dural arteriovenous fistulas were treated in 132 treatment procedures. Treatment success and complete occlusion rates were 81.8% and 90.9%, respectively. After a mean follow-up of 23.6 months, 95.5% of the patients showed complete symptom remission or symptom relief. The overall complication rate was 8.3% (4.5% asymptomatic, 2.3% transient, and 1.5% permanent complications). Logistic regression showed that ≥10 feeding arteries (= .041) and involvement of the ascending pharyngeal artery (= .039) significantly lowered the probability of treatment success. Treatment success tended to be lower for low-grade dural arteriovenous fistulas, Cognard type I dural arteriovenous fistulas, and dural arteriovenous fistulas with involvement of dural branches of the internal carotid artery, however without reaching statistical significance in the multivariable model.
CONCLUSIONS
The presence of multiple feeding arteries and involvement of the pharyngeal artery negatively influence the treatment success of endovascular embolization of cranial dural arteriovenous fistulas with Onyx.
背景与目的
血管内栓塞治疗颅外硬脑膜动静脉瘘是一种有效的方法。然而，仍有相当一部分硬脑膜动静脉瘘不能得到充分治疗。本研究旨在报告我们单中心应用 Onyx 栓塞治疗硬脑膜动静脉瘘的经验，包括探讨血管构筑特征对治疗成功的影响。
材料与方法
评估临床资料、血管构筑特征、并发症、治疗成功率（定义为低级别硬脑膜动静脉瘘完全症状缓解和高级别硬脑膜动静脉瘘完全闭塞）和闭塞率。采用多变量向后逻辑回归分析各种血管构筑特征（包括位置、静脉引流模式、供血动脉数量和起源）的影响。
结果
104 例患者的 110 个硬脑膜动静脉瘘在 132 次治疗中接受了治疗。治疗成功率和完全闭塞率分别为 81.8%和 90.9%。平均随访 23.6 个月后，95.5%的患者症状完全缓解或减轻。总的并发症发生率为 8.3%（无症状 4.5%，短暂性 2.3%，永久性 1.5%）。逻辑回归显示，≥10 支供血动脉（=0.041）和咽升动脉受累（=0.039）显著降低了治疗成功率。低级别硬脑膜动静脉瘘、Cognard Ⅰ型硬脑膜动静脉瘘和颈内动脉硬脑膜分支受累的硬脑膜动静脉瘘治疗成功率较低，但在多变量模型中未达到统计学意义。
结论
存在多支供血动脉和咽升动脉受累会对应用 Onyx 栓塞治疗颅外硬脑膜动静脉瘘的治疗成功率产生负面影响。
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