Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage.
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Durnford Andrew J, Akarca Danyal, Culliford David, Millar John, Guniganti Ridhima, Giordan Enrico, Brinjikji Waleed, Chen Ching-Jen, Abecassis Isaac Josh, Levitt Michael, Polifka Adam J, Derdeyn Colin P, Samaniego Edgar A, Kwasnicki Amanda, Alaraj Ali, Potgieser Adriaan R E, Chen Stephanie, Tada Yoshiteru, Phelps Ryan, Abla Adib, Satomi Junichiro, Starke Robert M, van Dijk J Marc C, Amin-Hanjani Sepideh, Hayakawa Minako, Gross Bradley, Fox W Christopher, Kim Louis, Sheehan Jason, Lanzino Giuseppe, Kansagra Akash P, Du Rose, Lai Rosalind, Zipfel Gregory J, Bulters Diederik O, CONDOR Investigators
Аннотация
METHODS: Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.
RESULTS: Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).
CONCLUSIONS: The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.