Case Report
Spontaneous Closure of a Dural Arteriovenous Fistula Immediately after Cerebral Angiography Using a Gadolinium Contrast Agent

https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.06.019Get rights and content

Gadolinium (Gd) contrast agents have been used instead of iodinated contrast agents in patients in whom iodine is contraindicated, but cerebral angiography of a dural arteriovenous fistula (dAVF) using a Gd contrast agent has not previously been reported. We recently performed cerebral angiography using a Gd contrast agent in a patient with an anterior condylar confluence dAVF who was allergic to iodine. To our surprise, there was spontaneous closure of the dAVF immediately after angiography. We now report what we believe is the first such case report.

Introduction

Gadolinium (Gd) contrast agents can be used instead of iodinated contrast agents in patients in whom iodine is contraindicated. Angiography and endovascular intervention using Gd contrast agents have been reported for many vascular territories, including the head and neck vasculature.1, 2 However, cerebral angiography using Gd contrast agents for dural arteriovenous fistulas (dAVFs) has not been reported before, and the imaging quality and diagnostic ability have not been investigated. In addition, much remains unknown about the natural history of dAVFs, and although spontaneous closure is occasionally reported,3, 4, 5, 6 the mechanism involved has not been elucidated.

We recently performed cerebral angiography using a Gd contrast agent in a patient with an anterior condylar confluence (ACC) dAVF who was allergic to iodine. To our surprise, there was spontaneous closure of the dAVF immediately after angiography. This has not previously been reported.

Section snippets

Case Report

This patient was a 61-year-old man who was evaluated by our department for progressively worsening right-sided tinnitus over the previous 2-month period. A right postauricular bruit was heard on physical examination, but there were no other abnormal physical findings. A head computed tomography scan showed no specific abnormalities, but magnetic resonance angiography revealed findings suspicious of a right ACC dAVF with the right ascending pharyngeal artery as a feeding artery (Fig 1, A).

The

Discussion

Spontaneous closure of dAVFs has rarely been reported,3, 4, 5, 6 and the mechanism of spontaneous closure has not yet been elucidated. Thrombosis of the affected venous sinus,3 a mass effect or secondary vasospasm of the feeding arteries due to intracranial hemorrhage,4 and scar tissue during the healing process in the case of traumatic dAVFs5 may be involved in spontaneous obliteration. However, in our patient, the affected venous sinus was not thrombosed, and there was no history of

Conclusion

We have reported a previously unreported case of spontaneous closure of a dAVF immediately after cerebral angiography using a Gd contrast agent in a patient with an iodine allergy. The mechanism of spontaneous closure immediately after angiography may have been because of vascular endothelial cell injury of the shunt site caused by ionic hyperosmolality of Gd-DOTA.

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