Successful Transvenous Embolization of Brain Arteriovenous Malformations Using Onyx in Five Consecutive Patients

Abstract

The transvenous approach using Onyx for the management of BAVMs is shown to be an efficient and safe alternative treatment in cases with no other conventional therapeutic choice and when some anatomic considerations are respected.

Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

“…To the best of our knowledge, apart from very few case reports, 1,15 this is the first case series of brain AVM treatment via a transvenous endovascular approach. Although in the past transvenous endovascular techniques were con- sidered risky, 5,13 the concept of venous side occlusion for permanent AVM cure has been around for 2 decades.…”

“…20 Advances in liquid embolic materials have allowed for development and evolution of this technique. We have been using the presented protocol during the past few years in select cases, 15 and, in our experience, when rules are respected there is no increased hemorrhagic risk over intraarterial techniques. However, it is important to maintain an appropriate injection rate to exclude the nidus before occluding the initial part of the main draining venous outlet.…”

Balloon-assisted microcatheter navigation for AVM embolization: technical note

“…1,5,9,11,16 Familiarization of practitioners with the properties of Onyx and contemporary evolution of endovascular technology have afforded safety for prolonged injection time of liquid embolics. 1,8 Nevertheless, for accomplishing a successful AVM embolization, the close approach to the nidus remains the major determinant and must be pursued.…”

“…11 It allows the embolic agent to diffuse into the vascular apparatus of the shunt, sparing normal brain supply branches. 1,5,9,11,12,16 In some instances, especially in the deepest portion of the AVM, recurrent configuration and unfavorable angled loops at the origin of the feeders lead to unstable micro- catheter navigation. 7,9,15 Attempts to gain distal access result in prolapse of the system into the parent vessel.…”

“…1,5,9,11,12,16 In some instances, especially in the deepest portion of the AVM, recurrent configuration and unfavorable angled loops at the origin of the feeders lead to unstable micro- catheter navigation. 7,9,15 Attempts to gain distal access result in prolapse of the system into the parent vessel. 19 The struggling microcatheter navigation usually requires multiple attempts and excessive wire exchanges, leading to distal wire perforation in more than 3% of cases 2 and death in up to 4.6% of patients.…”