Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx

Hauck, Erik F.; Welch, Babu G.; White, Jonathan A.; Purdy, Phillip D.; Pride, L.G.; Samson, Duke

doi:10.3174/ajnr.a1376

Cited by 48 publications

(32 citation statements)

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“…The characteristics that make EVOH copolymer effective in the treatment of cerebrovascular lesions may benefit hemorrhagic lesions elsewhere in the body, and peripheral nonneurologic applications are becoming more accepted (2)(3)(4). Most of the literature on Onyx focuses on neurologic lesions (5,6) and chronic aortic endoleaks (7,8); the remaining literature on the topic largely comprises case reports and case series. In this study, we systematically reviewed the existing literature on the use of EVOH copolymer to treat acute hemorrhage outside of the head and neck to determine its efficacy and safety for use in peripheral lesions.…”

mentioning

confidence: 98%

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

Kolber

Shukla

Kumar

et al. 2015

Journal of Vascular and Interventional Radiology

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confidence: 98%

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

Kolber

Shukla

Kumar

et al. 2015

Journal of Vascular and Interventional Radiology

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“…[1][2][3][4][5][6] The aim of endovascular embolization is to achieve the occlusion of the nidus, preserving the venous outlet: the rationale is to devascularize the lesion, reducing the arterial blood flow into the nidus, and to maintain the patency of the venous drainage to avoid an increase in blood pressure in the AVM that could cause an intra-axial hemorrhage.…”

mentioning

confidence: 99%

Double Arterial Catheterization Technique for Embolization of Brain Arteriovenous Malformations With Onyx

et al. 2013

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“…Hauck et al 5 reported catheter entrapment in 4.9% of their AVM embolizations with Onyx. This has been addressed to some extent by the use of a new microcatheter with a detachable tip 6 ; however, this catheter is not available in the United States, and long-term associated outcomes are unknown.…”

Section: Discussionmentioning

confidence: 98%

Use of the Outreach Distal Access Catheter for Microcatheter Stabilization during Intracranial Arteriovenous Malformation Embolization

Binning

Yashar

Orion

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.ABBREVIATIONS: AVM ϭ arteriovenous malformation; DAC ϭ Distal Access Catheter; DSA ϭ digital subtraction angiography; n-BCA ϭ n-butyl 2-cyanoacrylate E ndovascular embolization is frequently used in the treatment of brain AVMs. These are occluded by injecting an adhesive embolizing agent, such as n-BCA, or a nonadhesive embolizing agent, such as Onyx (ev3/Covidien Vascular Therapies, Mansfield, Massachusetts). The complexity and location of many brain AVMs 1-3 cause the neurovascular interventionist to contend with large distances between the guide catheter and microcatheter, reducing the amount of support available for the microcatheter and guide for navigation. Particularly with the use of Onyx as an embolizing agent, encasement of the microcatheter in the Onyx cast can be seen. Furthermore, routine guide catheter runs obtained during DSA results in opacification of all cerebral vessels in the path of that cervical vertebral or carotid artery. This can result in masking of the AVM angioarchitecture because of overlying cerebral vessels.The Outreach DAC (Concentric Medical, Mountain View, California) is a 4.3F catheter designed to assist the Merci device (Concentric Medical) with clot retrieval in acute stroke. 4 In the authors' opinion, the DAC provides triaxial support to improve stabilization of the microcatheter and a safer exit route for the microcatheter, without adding significant complexity to the procedure, compared with embolization with a guide and microcatheter alone. We investigated its application as an adjunctive tool for embolization of intracranial AVMs. TechniqueAngiography is initiated with the patient under conscious sedation with common femoral artery access. Four-vessel cerebral angiography is performed with a 90-cm 6F Envoy catheter (Cordis, Miami Lakes, Florida) to assess AVM anatomy. The Envoy is advanced into the desired vertebral or carotid artery at the skull base and is placed under continuous flush. The patient is systemically heparinized (goal activated coagulation time, Ͻ250 seconds). A microcatheter (ie, 165-cm Marathon [ev3/Covidien Vascular Therapies]) is introduced through the 136-cm DAC and advanced over a Synchro-10 wire (Boston Scientific, Natick, Massachusetts). Both microcatheter and DAC are connected to a continuously heparinized and pressurized flush. As we advance the microcatheter into the desired feeding pedicles, the DAC is advanced over the microcatheter intracranially. We remove the microwire and microc...

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Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx

Abstract: BACKGROUND AND PURPOSE:Preoperative embolization facilitates the surgical management of complex cerebral arteriovenous malformations (cAVMs). This analysis aims to investigate the risks for preoperative cAVM embolization with Onyx.

Cited by 48 publications

References 20 publications

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

Double Arterial Catheterization Technique for Embolization of Brain Arteriovenous Malformations With Onyx

Use of the Outreach Distal Access Catheter for Microcatheter Stabilization during Intracranial Arteriovenous Malformation Embolization

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