Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage
Authors: Durnford Andrew J. , Akarca Danyal , Culliford David , Millar John , Guniganti Ridhima , Giordan Enrico , Brinjikji Waleed , Chen Ching-Jen , Abecassis Isaac Josh , Levitt Michael , Polifka Adam J. , Derdeyn Colin P. , Samaniego Edgar A. , Kwasnicki Amanda , Alaraj Ali , Potgieser Adriaan R.E. , Chen Stephanie , Tada Yoshiteru , Phelps Ryan , Abla Adib , Satomi Junichiro , Starke Robert M. , van Dijk J. Marc C. , Amin-Hanjani Sepideh , Hayakawa Minako , Gross Bradley , Fox W. Christopher , Kim Louis , Sheehan Jason , Lanzino Giuseppe , Kansagra Akash P. , Du Rose , Lai Rosalind , Zipfel Gregory J. , Bulters Diederik O. , Piccirillo Jay F. , Raman Hari , Lipsey; Kim , Vine Roanna , Cloft Harry J. , Kallmes David F. , Pollock Bruce E. , Link Michael J. , Patibandla Mohana Rao , Ding Dale , Buell Thomas , Paisan Gabriella , Meyer R. Michael , Kelly; Cory , Duffill Jonathan , Ditchfield Adam , Macdonald Jason , Laurent Dimitri , Hoh Brian , Smith Jessica , Lockerman Ashley , Lunsford L. Dade , Jankowitz Brian T. , Gutierrez Santiago Ortega , Hasan David , Roa Jorge A. , Rossen James , Guerrero Waldo , McGruder Allen , Charbel Fady T. , Aletich Victor A. , Rose-Finnell Linda , Peterson Eric C. , Yavagal Dileep R. , Sur Samir , Kanematsu Yasuhisa , Yamamoto Nobuaki , Kinouchi Tomoya , Korai Masaaki , Yamaguchi Izumi , Yamamoto Yuki , Winkler Ethan , Lawton Michael , Rutkowski Martin , Sultan M. Ali Aziz , Patel Nirav , Frerichs Kai U. 
Published: April 2022

Background:
Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.

Methods:
Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.

Results:

Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2–14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3–5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7–12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4–37.7;
P
, 0.026).

Conclusions:
The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.