The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration
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Published:2023-05-02
Issue:
Volume:
Page:jnis-2023-020282
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ISSN:1759-8478
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Container-title:Journal of NeuroInterventional Surgery
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language:en
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Short-container-title:J NeuroIntervent Surg
Author:
Becerril-Gaitan AndreaORCID, Ding DaleORCID, Ironside NatashaORCID, Buell Thomas J, Kansagra Akash PORCID, Lanzino Giuseppe, Brinjikji WaleedORCID, Kim Louis, Levitt Michael RORCID, Abecassis Isaac JoshORCID, Bulters Diederik, Durnford Andrew, Fox W ChristopherORCID, Blackburn Spiros, Chen Peng RocORCID, Polifka Adam J, Laurent DimitriORCID, Gross Bradley, Hayakawa Minako, Derdeyn ColinORCID, Amin-Hanjani Sepideh, Alaraj AliORCID, van Dijk J Marc C, Potgieser Adriaan R E, Starke Robert M, Peterson Eric C, Satomi Junichiro, Tada Yoshiteru, Abla Adib A, Winkler Ethan A, Du Rose, Lai Pui Man RosalindORCID, Zipfel Gregory J, Chen Ching-JenORCID, Sheehan Jason P
Abstract
BackgroundTools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes.MethodsPatients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC.ResultsA total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27–1.48)) with each additional point in the overall patient score (range 0–12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0–3 score to 72–89% for patients scoring ≥8.ConclusionThe VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.
Subject
Neurology (clinical),General Medicine,Surgery
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