Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis

• Published in: Stroke (1970) 2020-11, Vol.51 (11), p.3344-3347
• Main Authors: Ferro, José M., Coutinho, Jonathan M., Jansen, Olav, Bendszus, Martin, Dentali, Francesco, Kobayashi, Adam, van der Veen, Bas, Miede, Corinna, Caria, Jorge, Huisman, Holger, Diener, Hans-Christoph
• Format: Article
• Language: English
• Subjects: Adult; Anticoagulants - therapeutic use; Antithrombins - therapeutic use; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - epidemiology; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - epidemiology; Cerebral Angiography; Cerebral Veins; Cranial Sinuses - diagnostic imaging; Dabigatran - therapeutic use; Female; Humans; Imaging, Three-Dimensional; Intracranial Thrombosis - drug therapy; Intracranial Thrombosis - epidemiology; Magnetic Resonance Angiography; Male; Meningeal Arteries; Middle Aged; Randomized Controlled Trials as Topic; Secondary Prevention; Sinus Thrombosis, Intracranial - drug therapy; Sinus Thrombosis, Intracranial - epidemiology; Venous Thrombosis - drug therapy; Venous Thrombosis - epidemiology; Warfarin - therapeutic use
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.120.031235

BACKGROUND AND PURPOSE:This analysis examined the frequency of dural arteriovenous fistulae (dAVF) after cerebral venous thrombosis (CVT) in patients included in a randomized controlled trial comparing dabigatran etexilate with dose-adjusted warfarin (RE-SPECT CVT [A Clinical Trial Comparing Efficacy and Safety of Dabigatran Etexilate With Warfarin in Patients With Cerebral Venous and Dural Sinus Thrombosis]), who had systematic follow-up magnetic resonance (MR) imaging. METHODS:RE-SPECT CVT was a Phase 3, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded end point adjudication. We allocated patients with acute CVT to dabigatran 150 mg twice daily or dose-adjusted warfarin, for 24 weeks and obtained a standardized MR protocol including time-of-flight MR angiography, 3-dimensional phase-contrast venography, and 3-dimensional contrast-enhanced MR venography at the end of the treatment period. A blinded adjudication committee assessed the presence of dAVF in a predefined substudy of the trial. RESULTS:We analyzed development of dAVF in 112 of 120 randomized patients; 57 allocated to dabigatran and 55 to warfarin. For 3 (2.7%) of these 112 patients, quality of follow-up imaging was insufficient to evaluate dAVF. A dAVF (Borden I) was found in 1 patient (0.9%) allocated to warfarin; however, this dAVF was already present at baseline. The patient did not present with hemorrhage at baseline or during the trial and was asymptomatic at follow-up. CONCLUSIONS:Despite systematic imaging, we found no new dAVF 6 months after CVT. Routine follow-up cerebral MR angiography aiming to detect new dAVF 6 months after CVT has a very low yield. REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT02913326.