Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension

Thomas J. Buell, Daniel M. Raper, Dale DIng, Ching Jen Chen, Kenneth C. Liu

Research output: Contribution to journalArticle

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Abstract

We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.

Original languageEnglish (US)
Article number013282
JournalBMJ case reports
Volume2017
DOIs
StatePublished - Jan 1 2017

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Central Nervous System Vascular Malformations
Pseudotumor Cerebri
Stents
Venous Pressure
Platelet-Derived Growth Factor
Stainless Steel
Vascular Endothelial Growth Factor A
Veins
Thrombosis
Up-Regulation
Hemodynamics
Inflammation
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Buell, Thomas J. ; Raper, Daniel M. ; DIng, Dale ; Chen, Ching Jen ; Liu, Kenneth C. / Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. In: BMJ case reports. 2017 ; Vol. 2017.
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Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. / Buell, Thomas J.; Raper, Daniel M.; DIng, Dale; Chen, Ching Jen; Liu, Kenneth C.

In: BMJ case reports, Vol. 2017, 013282, 01.01.2017.

Research output: Contribution to journalArticle

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