TY - JOUR
T1 - Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas. Institutional Series, Systematic Review and Meta-Analysis
AU - Alexandre, Andrea M.
AU - Sturiale, Carmelo Lucio
AU - Bartolo, Andrea
AU - Romi, Andrea
AU - Scerrati, Alba
AU - Flacco, Maria Elena
AU - D'Argento, Francesco
AU - Scarcia, Luca
AU - Garignano, Giuseppe
AU - Valente, Iacopo
AU - Lozupone, Emilio
AU - Pedicelli, Alessandro
PY - 2022
Y1 - 2022
N2 - Purpose: Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods: PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results: A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion: A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.
AB - Purpose: Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. Methods: PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. Results: A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5–96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82–12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). Conclusion: A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.
KW - Carotico-cavernous d-AVF
KW - Carotid-cavernous fistula
KW - Endovascular treatment
KW - DAVF
KW - Cavernous sinus dural arteriovenous fistulas
KW - Carotico-cavernous d-AVF
KW - Carotid-cavernous fistula
KW - Endovascular treatment
KW - DAVF
KW - Cavernous sinus dural arteriovenous fistulas
UR - http://hdl.handle.net/10807/305316
U2 - 10.1007/s00062-021-01107-0
DO - 10.1007/s00062-021-01107-0
M3 - Article
SN - 1869-1439
VL - 32
SP - 761
EP - 771
JO - Clinical Neuroradiology
JF - Clinical Neuroradiology
ER -