Treatment of Brain Arteriovenous Malformations by Double Arterial Catheterization with Simultaneous Injection of Onyx: Retrospective Series of 17 Patients

Abstract

BACKGROUND AND PURPOSE:The use of Onyx in the treatment of intracranial AVMs has increased the cure rate of endovascular embolization compared with the use of liquid adhesive agents. Inadvertent occlusion of the draining veins before the complete exclusion of the nidus constitutes a major risk of bleeding. We report a case series using the technique of double simultaneous arterial catheterization as an approach to achieve the complete exclusion of the nidus before reaching the venous drainage, through a more controlled hemodynamic filling.

Balloon-assisted microcatheter navigation for AVM embolization: technical note

“…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.…”

“…1,5,9,11,16 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.…”

Curative Embolization of Brain Arteriovenous Malformations with Onyx: Patient Selection, Embolization Technique, and Results

“…Also other operators reported cure rates Յ94% of embolization of selected AVMs. 1,[3][4][5][6][7] In all studies, the same angioarchitectural features of the AVMs predispose them to complete obliteration.…”

“…With growing experience, advanced biplane imaging with rapid subtraction fluoroscopy, and refinements of technique in the use of Onyx, a considerable proportion of small and intermediate-sized brain AVMs can be completely obliterated at a low complication rate, on the condition that the nidus is accessible by the microcatheter with feeders suitable for the injection with Onyx, allowing of 2-3 cm of reflux. [1][2][3][4][5][6][7][8] In AVMs presenting with intracranial hemorrhage, better recognition of certain angioarchitectural features of the AVM as likely weak spots prone to recurrent hemorrhage, such as intranidal-and flow-related aneurysms and venous stenoses, has prompted many operators to perform a partial targeted embolization treatment when complete AVM obliteration is unlikely or impossible. [9][10][11][12][13][14] The growing experience with the use of Onyx in our department together with advancement in imaging possibilities and the adjustment of the technique of curative embolization have gradually resulted in the adaptation of the treatment paradigm of patients with AVMs in our hospital.…”

Percutaneous transcatheter embolization with n-butyl cyanoacrylate of hepatic hemorrhagic lesions in urgent situations

“…Some authors have used Onyx to treat acute bleeding with good results (29). We feel that Onyx is indicated for situations in which long injections of material are needed to achieve better filling of the lesion, usually for intracranial (30,31) and peripheral (32) vascular malformations. With active bleeding, although Onyx can be used, we consider NBCA superior due to the ability to alter its concentration and hence the polymerization time.…”