Thirteen-Year Trends and Advancements of Endovascular Therapy for Dural Arteriovenous Fistulas in Japan: Insights from a Nationwide Study of 6470 Procedures
- PMID: 40389268
- DOI: 10.3174/ajnr.A8840
Thirteen-Year Trends and Advancements of Endovascular Therapy for Dural Arteriovenous Fistulas in Japan: Insights from a Nationwide Study of 6470 Procedures
Abstract
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.
© 2025 by American Journal of Neuroradiology.
Conflict of interest statement
All authors who are members and non-members of the Japan Neurosurgical Society (JNS) have registered self-reported conflicts of interest disclosure statements through the website for JNS. Kenji Sugiu reports lecturer’s fee from Medtronic, Terumo, and Kaneka. Koji Iihara receives research grant from Idorsia Pharmaceutical Japan. Hirotoshi Imamura reports lecturer’s fees from Medtronic, Terumo, Stryker, Daichi Sankyo, Johnson & Johnson, and Asahi Intec. Akira Ishii received lecture fees from Medtronic, Stryker, Terumo, Kaneka, Asahi Intec, and Daiichi Sankyo. Yuji Matsumaru discloses lecturer fees from Medtronic, Stryker, Terumo, Kaneka, Biomedical solution, E.P. Medical, B Braun, Daiichi Sankyo and Idorsia Pharmaceutical Japan outside the submitted work. Tetsu Satow reports research grants from CANON medical systems, lecturer's fees from Medtronic, and consulting fees from Kaneka Medix, all outside the submitted work. Shinichi Yoshimura received speakers’ bureau/honoraria from Daiichi Sankyo, Bristol-Meyers Squibb, Stryker, Medtronic, Kaneka Medics, Terumo, Boehringer-Ingelheim, Bayer, Johnson & Johnson, Idorsia, Eisai. Nobuyuki Sakai reports a research grant from Biomedical Solutions, Medtronic, Terumo and TG Medical; lecturer’s fees from Asahi-Intec, Biomedical Solutions, Daiichi-Sankyo, Kaneka, Medtronic, and Terumo; membership on the advisory boards for Johnson & Johnson, Medtronic and Terumo outside the submitted work. Other coauthors have no conflicts of interest for this manuscript.
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