Thirteen-Year Trends and Advancements of Endovascular Therapy for Dural Arteriovenous Fistulas in Japan: Insights from a Nationwide Study of 6470 Procedures.

BACKGROUND AND PURPOSE: Endovascular therapy for dural arteriovenous fistulas (dAVFs) has evolved with advancements in imaging technology and devices. However, few large-scale, nationwide studies have been reported. This study aimed to investigate the trends and advancements in endovascular therapy for dAVFs during the past 13 years.

MATERIALS AND

METHODS

We identified patients from the Japanese Registry of Neuroendovascular Therapy (JR-NET) database treated for dAVFs between 2007 and 2019. We compared patient demographics, disease characteristics, treatment methods, and outcomes for JR-NET2 (2007-2009), JR-NET3 (2010-2014), and JR-NET4 (2015-2019). Prediction of complications was evaluated using multivariate logistic regression analysis.

RESULTS

In total, we analyzed 6470 procedures. When we compared JR-NET2, 3, and 4, we found that the treatment for tentorial and anterior cranial fossa dAVFs has increased, and the use of precipitating liquid materials in transarterial embolization (TAE) increased to 31.7%. Complete obliteration in TAEs alone increased to 38.0%, with no significant changes in complication rates, morbidity, or mortality at 30 days. In JR-NET2 and 3, complications were significantly associated with the cavernous sinus, tentorium, anterior cranial fossa, and emergency treatment. In JR-NET4, aggressive symptoms and precipitating liquid embolic materials were significantly correlated with complications. Supervision by senior trainers significantly reduced complications.

CONCLUSIONS

The use of precipitating liquid embolic materials has improved TAE outcomes. While their use has also emerged as a new risk factor for complications, supervision by senior trainers has been shown to mitigate these risks.