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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2021.tde-05072021-153921
Document
Author
Full name
Marco Túlio Salles Rezende
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Abud, Daniel Giansante (President)
Júnior, Jorge Elias
Raso, Jair Leopoldo
Santos, Antonio Carlos dos
Title in Portuguese
Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha
Keywords in Portuguese
Angiografia cerebral
Embolização terapêutica
Endovascular
Fístula arteriovenosa/tratamento
Abstract in Portuguese
Introdução: Nas últimas décadas, o tratamento endovascular (TEV) tornou-se a primeira opção terapêutica para a maioria das fístulas arteriovenosas durais tentoriais (FAVDTs). O TEV é associado a melhores resultados clínicos, entretanto, as taxas de oclusão angiográfica são inferiores em relação a microcirurgia ou tratamento combinado. Objetivo: avaliar a eficácia e a segurança do TEV das FAVDTs usando a via arterial como estratégia de primeira linha. Métodos: foram retrospectivamente revisados dados clínicos e radiológicos de 45 pacientes consecutivos, portadores de FAVDTs, tratados por via endovascular. Resultados clínicos e angiográficos imediatos e seis meses após o procedimento foram avaliados. Regressão logística univariada e multivariada foram realizadas para identificar preditores de oclusão angiográfica após a primeira sessão de TEV e de complicações clínicas. Resultados: a via arterial foi realizada de forma isolada em 40 FAVDTs (88,9%); 37 (82,2%) FAVDTs foram completamente ocluídas após a primeira sessão de TEV e 44 FAVDTs (97,8%) foram ocluídas após a última sessão de tratamento. A detecção de menos de cinco artérias nutridoras foi um preditor para oclusão total após a primeira sessão de TEV (Odds ratio, 18,9; 95% IC 2,06-173,57; p=0,01). Angiografia de controle após seis meses do TEV foi realizada em 41 pacientes e todas as FAVDTs encontravam-se ocluídas. Resultados neurológicos satisfatórios em longo prazo foram observados em 41 pacientes (91,1%). Complicações clínicas ocorreram em sete (15,6%), pacientes sendo relacionadas ao número de artérias acessadas durante o TEV (Odds ratio, 2,53; 95% IC 1,10-5,86; p=0,03). A taxa de mortalidade relacionada ao procedimento foi de 2,2%. Conclusão: a via arterial é um tratamento seguro e eficaz para as FAVDTs.
Title in English
Endovascular treatment of tentorial dural arteriovenous fístulas using the transarterial approach as a first-line strategy
Keywords in English
Arteriovenous fístula
Cerebral angiography
Dural arteriovenous fístula
Embolization
Tentorium cerebelli
Abstract in English
Background: In recent decades, the endovascular approach has become the standard treatment for most tentorial dural arteriovenous fistulas (TDAVFs). Although endovascular treatment (EVT) is associated with better clinical outcomes, the angiographic occlusion rates are lower than those of surgical or combined approaches. Objective: To evaluate the efficacy and safety of EVT for TDAVFs using the transarterial approach (TAA) as a first-line strategy. Methods: Clinical and radiological data of 45 consecutive patients with TDAVFs who underwent EVT at two centers were retrospectively reviewed. Patient demographics and clinical and angiographic data were registered. Postprocedural and 6-month follow-up angiographic and clinical results were evaluated. Univariable and multivariable logistic regression were performed to identify angiographic occlusion predictors after the first session and predictors of clinical complications. Results: An isolated TAA was used for 40 TDAVFs (88.9%). Thirty-seven (82.2%) TDAVFs were completely occluded with a single EVT session, and 44 TDAVFs (97.8%) were completely occluded with the last procedure. Having less than 5 arterial feeders was a predictor for total occlusion after the first treatment session (odds ratio, 18.9; 95% CI 2.06- 173.57; P= .01). Six-month angiographic control was performed in 41 patients, and all TDAVFs were occluded. Long-term good neurological outcomes were observed in 41 patients (91.1%). Clinical complications occurred in seven (15.6%) patients. They were related to the number of accessed arteries to perform TAA (odds ratio, 2.53; 95% CI 1.10-5.86; P= .03). The procedure-related mortality rate was 2.2%. Conclusion: The TAA is a safe and effective treatment for TDAVFs.
 
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Publishing Date
2021-07-12
 
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