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Early rebleeding of intracranial dural arteriovenous fistulas after an intracranial hemorrhage

  • Original Article - Vascular
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Abstract

Background

The aim of this study was to evaluate the clinical and angiographic characteristics of dural arteriovenous fistulas (DAVF) presenting with intracranial hemorrhage (ICH), with a focus on early rebleeding according to the initial hemorrhage type.

Method

The clinical and radiologic features of 21 dAVFs that presented with intracranial hemorrhage were retrospectively reviewed. The hemorrhage type was classified as pure intraparenchymal hemorrhage (pIPH) and subarachnoid or subdural hemorrhage with IPH (non-pIPH).

Results

There were 13 patients with pIPH and 8 with non-pIPH. The median follow-up period was 30 months (range, 1–116 months), and the median interval from hemorrhage to treatment was 4 days (range, 0–72 days). Rebleeding occurred in 8 (38.1%) of 21 patients. Four (50%) of eight patients with non-pIPH suffered from early rebleeding within 3 days, while there was no early rebleeding in patients with pIPH. There was a significantly higher rate of early rebleeding in the non-pIPH group (p = 0.012). Angiographically, venous ectasia (p = 0.005) and direct cortical venous drainage (dCVD) (p = 0.008) showed a significantly higher proportion in the non-pIPH group than in the pIPH group.

Conclusions

DAVFs with ICH is likely to rebleed after the first hemorrhage. Thus, early treatment can be needed in all DAVFs with ICH. In addition, DAVFs that presenting with non-pIPH and containing venous ectasia or dCVD on initial angiography may have a higher risk of early rebleeding. Therefore, cautious attention and urgent treatment are necessary for these patients.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea

    Jai Ho Choi

  2. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Kyung Il Jo, Je Young Yeon, Jong Soo Kim & Seung Chyul Hong

  3. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, 06351, Seoul, South Korea

    Keon Ha Kim & Pyoung Jeon

Authors
  1. Jai Ho Choi
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  2. Kyung Il Jo
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  3. Keon Ha Kim
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  4. Pyoung Jeon
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  5. Je Young Yeon
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  6. Jong Soo Kim
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  7. Seung Chyul Hong
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Correspondence to Pyoung Jeon.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Choi, J.H., Jo, K.I., Kim, K.H. et al. Early rebleeding of intracranial dural arteriovenous fistulas after an intracranial hemorrhage. Acta Neurochir 159, 1479–1487 (2017). https://doi.org/10.1007/s00701-017-3226-9

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  • DOI: https://doi.org/10.1007/s00701-017-3226-9

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