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 (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.