RT Journal Article
SR Electronic
T1 Thirteen-Year Trends and Advancements of Endovascular Therapy for Dural Arteriovenous Fistulas in Japan: Insights from a Nationwide Study of 6470 Procedures
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8840
DO 10.3174/ajnr.A8840
A1 Murai, Satoshi
A1 Hishikawa, Tomohito
A1 Hiramatsu, Masafumi
A1 Haruma, Jun
A1 Sugiu, Kenji
A1 Iihara, Koji
A1 Imamura, Hirotoshi
A1 Ishii, Akira
A1 Matsumaru, Yuji
A1 Sakai, Chiaki
A1 Satow, Tetsu
A1 Yoshimura, Shinichi
A1 Sakai, Nobuyuki
A1 Japanese Registry of Neuroendovascular Therapy (JR-NET) Investigators
YR 2025
UL http://www.ajnr.org/content/early/2025/05/19/ajnr.A8840.abstract
AB BACKGROUND AND PURPOSE: Endovascular therapy (EVT) 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 EVT for dAVFs over 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 between JR-NET2 (2007–2009), JR-NET3 (2010–2014) and JR-NET4 (2015–2019). Predictive factors of complications were evaluated using multivariate logistic regression analysis.RESULTS: In total, we analyzed 6,470 procedures. Comparing JR-NET2, 3, and 4, 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 TAE alone increased to 38.0%, with no significant changes in complication rates, morbidity, or mortality at 30 days. In JR-NET2&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.ABBREVIATIONS: CVR = cortical venous reflux; dAVFs = dural arteriovenous fistulas; EVT = endovascular therapy; JR-NET = Japanese Registry of Neuroendovascular Therapy = JSNET, Japanese Society for Neuroendovascular Therapy; TAE = transarterial embolization; TVE = transvenous embolization.