Endovascular Treatment of Noncavernous Dural Arteriovenous Fistulas: Analysis of Outcomes with and without Ethylene Vinyl Alcohol

Objective: Noncavernous dural arteriovenous fistulas (DAVFs) are uncommon lesions that can be treated from an endovascular approach using various embolic materials. The purpose of this study was to evaluate our outcomes for endovascular treatment of DAVFs with and without the use of ethylene vinyl alcohol (EVOH). Methods: We performed a retrospective analysis of 65 patients treated for DAVF at our institution from January 1995 to May 2015. Lesions were classified as aggressive or benign, based on angiography according to Cognard classification. Demographic data, medical comorbidities, presenting symptoms, treatment modality, treatment outcomes, and complications were evaluated for each group. Primary outcome was defined as angiographic occlusion for an aggressive DAVF, and resolution of clinical symptoms for a benign DAVF. Results: The primary outcome was met in 47 (82.5%) of 57 cases with endovascular therapy alone; 23 (69.7%) of 33 aggressive fistulas; and 24 (100.0%) of 24 benign fistulas. There was a 5% overall complication rate. The primary outcome was achieved via endovascular approach in 80.0% (24 of 30) of cases with EVOH, and 85.2% (23 of 27) of cases without EVOH (P = .73). There was a 6% complication rate for procedures using EVOH versus 3% for cases without EVOH (P = 1.00), a 13% clinical recurrence rate for cases using EVOH compared to .0% when EVOH was not used (P = .24), and no angiographic recurrences in either group (P = 1). There were no procedure-related mortalities. Conclusions: Endovascular treatment of DAVFs has a high success rate and low complication rate. Our experience demonstrated no difference in outcomes between lesions treated with EVOH and those treated without EVOH. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.