Spontaneous Angiographic Conversion of Intracranial Dural Arteriovenous Shunt

Kim, Dong Joon; terBrugge, Karel G.; Krings, Timo; Willinsky, Robert A.; Wallace, Christopher

doi:10.1161/strokeaha.110.581462

Cited by 66 publications

(70 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Performing additional investigations in patients with DAVS who reveal a change in symptoms has been generally accepted. 2 However, on the basis of our results, it may be prudent to perform periodic angiographic follow-up studies, especially in those cases with evidence of sinus thrombosis due to the risks of silent aggressive metachronous lesion development. Noninvasive studies such as time-resolved MRA imaging may be a safe and effective technique for follow-up.…”

Section: Discussionmentioning

confidence: 85%

“…23 In addition to its pathogenic potential, sinus thrombosis is also known to be associated with spontaneous healing or pattern conversion of DAVSs. 2 Depending on the underlying venous topography, the upstream or downstream development of sinus thrombus may alter the venous outflow pattern or may be associated with spontaneous cure.…”

Section: Discussionmentioning

confidence: 99%

“…These are dynamic lesions and can show spontaneous healing or pattern changes on follow-up DSA. 1,2 DAVSs compose approximately 10% of all intracranial vascular malformations. 3 They are generally considered to be acquired diseases in the adult as opposed to other intracranial vascular malformations, but their pathomechanism in terms of lesion development and temporal changes has not been clearly established.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical and Angiographic Characteristics of Multiple Dural Arteriovenous Shunts

Kwon

Kim

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Angiographic Characteristics of Multiple Dural Arteriovenous Shunts

Kwon

Kim

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…With long-term follow-up, up to 12% of untreated patients may experience spontaneous resolution -most commonly in the transverse and cavernous sinuses [9] -although this timeframe is across many years, and the flow rate of these occluded DAVFs is unclear.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Regression of a Large High-Flow Intracranial Dural Arteriovenous Fistula

Aj¹

2017

Austin J Cerebrovasc Dis & Stroke

View full text Add to dashboard Cite

Dural arteriovenous fistulas (DAVFs) are vascular anomalies that form a connection between meningeal vessels and dural venous sinuses or cortical veins. A 47-year-old female with a history of rheumatoid arthritis and hypercoagulable state treated with warfarin was found to have a large transverse sinus DAVF with high-flow fast arteriovenous shunting. Her initial diagnostic angiogram performed at an outside institution clearly showed the large DAVF. Eight months later, a second diagnostic angiogram demonstrated that her DAVF had spontaneously resolved. Spontaneous regression of a DAVF is rare, and this is the largest DAVF that our institution has seen to resolve on its own. DAVFs have previously been known to spontaneously resolve, but few cases have been reported since it was first described in 1976. The mechanism for spontaneous closure is unknown, but several different mechanisms have been proposed. We postulate that spontaneous regression in this patient is related to her underlying hypercoagulable state and the high-flow nature of the DAVF. High-flow DAVFs can resolve spontaneously, and cautious modification of anticoagulation in select patients in order to induce fistula thrombosis may provide an avenue of management to consider. Her past medical history is significant for rheumatoid arthritis and the above-mentioned hypercoagulable state, as well as a remote history of several DVTs. She has no history of smoking, other tobacco use, alcohol use, or illicit drug use. Her brother is also noted to have a hypercoagulable state.Although the patient was prescribed a low molecular weight heparin bridge between her usual warfarin and the time of angiography at our institution, that prescription was not filled. Thus, the patient's warfarin was stopped four days prior to her procedure with no anticoagulant bridging. Upon presentation to our institution, Case PresentationIntracranial dural arteriovenous fistulas (DAVFs) are rare vascular malformations that connect meningeal arteries to dural venous sinuses or cortical veins. They were originally believed to be benign lesions compared to pial arteriovenous malformations (AVMs) until intracranial hemorrhage from a DAVF was observed [1]. Although hemorrhage from ruptured cortical venous varices is the most serious and worrisome complication, DAVFs can present with a variety of symptoms, including headaches, seizures, pulsatile tinnitus, and vision disturbances. Few DAVFs have been reported to resolve spontaneously since the phenomenon was first described in 1976 [2]. The reason for spontaneous closure is largely unknown, although several mechanisms have been proposed. In this report, we describe a case of spontaneous resolution of a large DAVF in a patient with a hypercoagulable state.A 47-year-old female was seen at an outside institution and found to have a large transverse sinus DAVF with high-flow fast arteriovenous shunting. One year prior to discovery of the DAVF, she underwent work-up at an outside institution for a seven-year history of daily occipital he...

show abstract

“…Arterial supply may be unilateral or bilateral, and venous drainage is toward the ipsilateral, contralateral, or both sides of the cavernous sinus. These fistulas may present with cortical venous reflux, but more commonly they drain antegradely, 12 from the cavernous sinus toward the SOV and/or the inferior petrosal sinus, with no CVR. Although their drainage is frequently antegrade, symptoms may be severe and include loss of vision related to venous congestion of the orbit.…”

mentioning

confidence: 99%

Ophthalmic vein compression for selected benign low-flow cavernous sinus dural arteriovenous fistulas

Cruz¹,

Dijk²,

Krings³

et al. 2013

JNS

Self Cite

View full text Add to dashboard Cite

Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are acquired arteriovenous shunts between the dural branches of the internal and external carotid arteries and the cavernous sinus. These fistulas may present with cortical venous reflux, but more commonly drain antegradely toward the superior ophthalmic vein (SOV). Transvenous embolization is the most common endovascular treatment, but in some cases transvenous access to the compartment of the shunt may not be possible. In cases with no corticovenous reflux, manual compression of the SOV is an excellent alternative treatment, which is well known but rarely reported in the literature. The authors describe a series of 3 cavernous DAVFs with anterior drainage treated successfully by intermittent manual compression of the SOV.

show abstract

Spontaneous Angiographic Conversion of Intracranial Dural Arteriovenous Shunt

Cited by 66 publications

References 27 publications

Clinical and Angiographic Characteristics of Multiple Dural Arteriovenous Shunts

Clinical and Angiographic Characteristics of Multiple Dural Arteriovenous Shunts

Spontaneous Regression of a Large High-Flow Intracranial Dural Arteriovenous Fistula

Ophthalmic vein compression for selected benign low-flow cavernous sinus dural arteriovenous fistulas

Contact Info

Product

Resources

About