Brain dural arteriovenous fistulas in the COVID-19 Era: A warning and rationale for association

Sergio Garcia-Garcia; Santiago Cepeda; Ignacio Arrese; Rosario Sarabia

doi:10.1016/j.clineuro.2022.107367

Brain dural arteriovenous fistulas in the COVID-19 Era: A warning and rationale for association

Clin Neurol Neurosurg. 2022 Sep:220:107367. doi: 10.1016/j.clineuro.2022.107367. Epub 2022 Jul 14.

Authors

Sergio Garcia-Garcia¹, Santiago Cepeda², Ignacio Arrese³, Rosario Sarabia⁴

Affiliations

¹ Neurosurgery Department, Hospital Universitario Río Hortega, Valladolid, Spain. Electronic address: iskender_brave@hotmail.com.
² Neurosurgery Department, Hospital Universitario Río Hortega, Valladolid, Spain. Electronic address: cepeda_santiago@hotmail.com.
³ Neurosurgery Department, Hospital Universitario Río Hortega, Valladolid, Spain. Electronic address: iarreser@saludcastillayleon.es.
⁴ Neurosurgery Department, Hospital Universitario Río Hortega, Valladolid, Spain. Electronic address: rsarabia@saludcastillayleon.es.

Abstract

Objectives: Brain dural arteriovenous fistulas(bDAVFs) are anomalous connections between dural arteries and cerebral veins or sinuses. Cerebral venous thrombosis(CVT) often precedes or coincides with bDAVFs and is considered a risk factor for these vascular malformations. Recently, vaccine-induced thrombotic thrombocytopenia causing CVTs has been associated with COVID-19 vaccines. Concurrently with the start of massive vaccination in our region, we have observed a fivefold increase in the average incidence of bDAVFs. Our objective is to raise awareness of the potential involvement of COVID-19 vaccines in the pathogenesis of bDAVF.

Methods: A retrospective review of demographic, clinical, radiological, COVID-19 infection and vaccination data of patients diagnosed with bDAVFs between 2011 and 2021 was conducted. Patients were divided into two cohorts according to their belonging to pre- or post-COVID-19 vaccination times. Cohorts were compared for bDAVFs incidences and demographic and clinical features.

Results: Twenty-one bDAVFs were diagnosed between 2011 and 2021, 7 of which in 2021. The mean age was 57.7 years, and 62 % were males. All cases except one were treated; of them, 85 % exclusively managed with surgery. All treated cases were successfully occluded. The incidence in 2021 was significantly higher than that in the prevaccination period (1.72 vs 0.35/100,000/year;p = 0.036; 95 %Confidence Interval=0.09-2.66). Cohorts were not different in age, sex, hemorrhagic presentation, dural sinus thrombosis or presence of prothrombotic or cardiovascular risk factors.

Conclusion: The significant increase in the incidence of bDAVF following general vaccination policies against COVID-19 observed in our region suggests a potential correlation between these two facts. Our findings need confirmation from larger cohorts and further pathogenic research.

Keywords: Brain dural arteriovenous fistula; COVID-19; Cerebral venous thrombosis; Neurovascular; Pathogenesis; Vaccine; Warning.

MeSH terms

Brain / pathology
COVID-19 Vaccines
COVID-19* / epidemiology
Central Nervous System Vascular Malformations* / surgery
Cerebral Angiography
Female
Humans
Male
Middle Aged

Substances

COVID-19 Vaccines