scholarly journals Safety and Feasibility of Balloon-Assisted Embolization with Onyx of Brain Arteriovenous Malformations Revisited: Personal Experience with the Scepter XC Balloon Microcatheter

2018 ◽  
Vol 7 (6) ◽  
pp. 439-444 ◽  
Author(s):  
Bharathi D. Jagadeesan ◽  
Andrew W. Grande ◽  
Ramachandra P. Tummala
Keyword(s):  
Retrospective Study ◽  
Vinyl Alcohol ◽  
Personal Experience ◽  
Arteriovenous Malformations ◽  
Pial Arteries ◽  
Ethylene Vinyl Alcohol ◽  
Brain Arteriovenous Malformations ◽  
Pial Vessel ◽  
Brain Avms ◽  
Vessel Rupture

Background/Objective: Compliant dual-lumen balloon microcatheters have been used to perform balloon-assisted embolization (BAE) of brain arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (Onyx). However, vessel rupture and microcatheter retention have been reported from BAE using these microcatheters. Using an extra-compliant balloon microcatheter (Scepter XC; Microvention, Tustin, CA, USA) could help avoid pial vessel rupture during BAE. We herein report our experience using this balloon microcatheter for BAE. Methods: This retrospective study included patients who underwent BAE of brain AVMs at our institution between June 2012 and March 2017. Results: The extra-compliant Scepter XC balloon microcatheter was used for BAE of brain AVMs in 23 patients aged 44.3 ± 16.7 years (range 0–65 years). A total of 40 intracranial vessels (39 pial arteries and 1 pial vein) were catheterized and embolized during 30 separate sessions. In all instances, the balloon microcatheter could be successfully advanced to the AVM nidus. A mean volume of 2.4 ± 1.7 mL (range 0.65–4.6 mL) of Onyx was injected per session. There were no instances of vessel rupture, microcatheter retention, or stroke. Conclusion: Utilization of the extra-compliant balloon microcatheter results in safe and effective BAE, which adds to the growing experience with BAE for AVM treatment.

Abstract TMP120: Endovascular Balloon-Assisted Embolization of Intracranial Arteriovenous Malformations Using Dual Lumen Co-Axial Balloon Microcatheters and Onyx: Initial Experience.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Bharathi D Jagadeesan ◽  
Mikayel Grigoryan ◽  
Ameer E Hassan ◽  
Andrew W Grande ◽  
Ramachandra P Tummala
Keyword(s):  
Arteriovenous Malformations ◽  
Balloon Catheter ◽  
Arterial Embolization ◽  
Initial Experience ◽  
Intracranial Arteriovenous Malformations ◽  
Balloon Inflation ◽  
Ethylene Vinyl Alcohol ◽  
Catheter Navigation ◽  
Brain Avms ◽  
Vessel Rupture

Background: Ethylene Vinyl alcohol co-polymer (Onyx) is widely used for embolization of intracranial arteriovenous malformations. Traditional catheter based techniques for Onyx infiltration may be associated with reflux of Onyx resulting in cathteter retention, vessel rupture or reflux into en-passage arteries. Balloon assisted Onyx embolization may eliminate some of these problems encountered with traditional catheter based techniques. Herein, we report our initial experience in performing balloon assisted AVM embolization for brain AVMs and dural AVFs using the new Scepter-C and Scepter-XC co- axial dual lumen balloon microcatheters. Methods: Balloon-assisted trans-arterial embolization was carried out in a series of six patients (5 with brain AVMs, one with a dural AVF ) using Onyx delivered through the lumen of Scepter-C or Scepter XC co-axial balloon microcatheters. Following initial balloon-catheter navigation into a feeding artery as close to the nidus of the malformation as possible, and subsequent balloon inflation, embolization was performed using Onyx 18 or Onyx 34 or both. The balloon was delated and removed once adequate embolization had been achieved. Results: A total of ten embolization sessions were performed via fifteen arterial feeders in these five patients. In one out of fifteen vessels (7%), there was a quickly controlled arterial perforation from balloon inflation, in all others embolization goals for each session were successfully achieved with no adverse events. Conclusion: We found that the balloon microcatheters showed excellent navigability and there were no problems with retrieval or repeated inflation and deflation of the balloons. Using this technique, we were able to avoid the need for formation of a proximal Onyx plug and its associated risks. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.

scholarly journals Endovascular Treatment of Brain Arteriovenous Malformations Using Onyx: Preliminary Results of a Prospective Multicenter Study

2005 ◽  
Vol 11 (1_suppl) ◽  
pp. 159-164 ◽  
Author(s):  
L. Pierot ◽  
A. C. Januel ◽  
D. Herbreteau ◽  
X. Barreau ◽  
J. Drouineau ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Value ◽  
Multicentric Study ◽  
Ethylene Vinyl Alcohol ◽  
Complete Occlusion ◽  
Preliminary Results ◽  
Liquid Polymer ◽  
Brain Arteriovenous Malformations ◽  
Permanent Occlusion ◽  
Brain Avms

The main final goal of the treatment of brain AVMs is to prevent bleeding and to obtain a complete occlusion of the nidus. The strategy of treatment of brain arteriovenous malformations (AVM) has to be defined by a multidisciplinary team and will usually combine several modalities (surgery, radiosurgery, embolization). Embolization is generally the first step of treatment. Occasionally embolization is able to completely occlude a small AVM. Otherwise embolization is the first step before surgery or radiosurgery. Several embolic agents have been proposed for embolization of brain AVMs like particles or cyanoacrylates. The main disadvantage of particles is the high frequency of recanalization. The cyanoacrylates are probably more appropriate, providing a permanent occlusion. However, due to the polymerizing characteristics of the glue, the time of injection is relatively short (few seconds or minutes) and a complete or substantial occlusion of the nidus is difficult to obtain, especially in the case of medium or largesized AVMs. Onyx is a nonadhesive liquid polymer made of a mixture of ethylene-vinyl-alcohol copolymer and dimethylsulfoxide. The theoretical advantage of a nonadhesive liquid is to eliminate the risk of gluing the microcatheter and subsequently to perform a more durable injection with a larger amounts of agent delivered in a single injection. Several French centers have undertaken a prospective, multicentric study to evaluate the clinical value of Onyx in embolization of brain AVMs. As required, 50 patients were included. Preliminary results are presented regarding the first 48 patients, the last 2 patients being included after writing of this paper. The treatment is now completed in 15 patients. As expected, it was possible with Onyx to perform long duration injections (5 to 70 minutes with a mean of 34 minutes). Volumes injected per session were also important (0.25 to 6 ml with a mean of 1.6 ml). According to the clinical experience of the centers, duration and volume injected were most important with Onyx than with cyanoacrylates. Out of the 15 patients for whom embolization is now completed, 14 had a percentage of occlusion of the nidus greater than 60% (with 2 complete occlusion).

Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S74-S82 ◽  
Author(s):  
R. Webster Crowley ◽  
Andrew F. Ducruet ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Endovascular Treatment ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Brain Arteriovenous Malformations ◽  
Short Period ◽  
Cerebral Avms ◽  
Brain Avms ◽  
The Brain ◽  
The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

Brain arteriovenous malformations

Neurology ◽  
2020 ◽  
Vol 95 (20) ◽  
pp. 917-927 ◽  
Author(s):  
Ching-Jen Chen ◽  
Dale Ding ◽  
Colin P. Derdeyn ◽  
Giuseppe Lanzino ◽  
Robert M. Friedlander ◽  
...  
Keyword(s):  
Natural History ◽  
Minimally Invasive ◽  
Arteriovenous Malformations ◽  
Cerebral Arteries ◽  
Treatment Strategies ◽  
Latency Period ◽  
Management Options ◽  
Brain Arteriovenous Malformations ◽  
Risk Of Hemorrhage ◽  
Brain Avms

Brain arteriovenous malformations (AVMs) are anomalous direct shunts between cerebral arteries and veins that convalesce into a vascular nidus. The treatment strategies for AVMs are challenging and variable. Intracranial hemorrhage and seizures comprise the most common presentations of AVMs. However, incidental AVMs are being diagnosed with increasing frequency due to widespread use of noninvasive neuroimaging. The balance between the estimated cumulative lifetime hemorrhage risk vs the risk of intervention is often the major determinant for treatment. Current management options include surgical resection, embolization, stereotactic radiosurgery (SRS), and observation. Complete nidal obliteration is the goal of AVM intervention. The risks and benefits of interventions vary and can be used in a combinatorial fashion. Resection of the AVM nidus affords high rates of immediate obliteration, but it is invasive and carries a moderate risk of neurologic morbidity. AVM embolization is minimally invasive, but cure can only be achieved in a minority of lesions. SRS is also minimally invasive and has little immediate morbidity, but AVM obliteration occurs in a delayed fashion, so the patient remains at risk of hemorrhage during the latency period. Whether obliteration can be achieved in unruptured AVMs with a lower risk of stroke or death compared with the natural history of AVMs remains controversial. Over the past 5 years, multicenter prospective and retrospective studies describing AVM natural history and treatment outcomes have been published. This review provides a contemporary and comprehensive discussion of the natural history, pathobiology, and interventions for brain AVMs.

The failure of preoperative ethylene-vinyl alcohol copolymer embolization to improve outcomes in arteriovenous malformation management: case series

2013 ◽  
Vol 118 (5) ◽  
pp. 969-977 ◽  
Author(s):  
Michael Kerin Morgan ◽  
Andrew Stewart Davidson ◽  
Stavros Koustais ◽  
Mary Simons ◽  
Elizabeth Anne Ritson
Keyword(s):  
Vinyl Alcohol ◽  
Adverse Outcome ◽  
Case Series ◽  
Adverse Outcomes ◽  
Selective Embolization ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Brain Avms ◽  
Second Period ◽  
Grade Iii

Object Ethylene-vinyl alcohol copolymer embolization is increasingly used preoperatively in the resection of brain arteriovenous malformations (AVMs). However, the case for embolization improving the outcome of resection has not been evaluated. In this paper the authors set out to compare outcomes after surgery for brain AVMs in 2 consecutive periods of practice. In the first period, selective embolization was used without the use of ethylene-vinyl alcohol copolymer. In the second period, selective embolization with ethylene-vinyl alcohol copolymer was performed. Methods A consecutive case series (prospectively collected data) was retrospectively analyzed. Adverse outcomes were considered to be an outcome modified Rankin Scale score greater than 2 due to embolization or surgery. Results A total of 538 surgical cases were included. The percentages of adverse outcomes were as follows: 0.34% for Spetzler-Martin AVMs less than Grade III (1 of 297 cases); 5.23% (95% CI 2.64%–9.78%) for Grade III AVMs (9 of 172 cases); and 17% (95% CI 10%–28%) for AVMs greater than Grade III (12 of 69 cases). There was no improvement in outcomes from the first period to the second period. The adverse outcome for Grade III brain AVMs in the first period was 5.2% (7 of 135 cases) and in the second period (after ethylene-vinyl alcohol copolymer was introduced) it was 5.4% (2 of 37 cases). For AVMs greater than Grade III, the adverse outcome was 12% (6 of 49 cases) in the first period and 30% (6 of 20 cases) in the second period. Conclusions Outcomes for brain AVM surgery were not improved by ethylene-vinyl alcohol copolymer embolization. Preoperative embolization of high-grade AVMs with an ethylene-vinyl alcohol copolymer did not prevent those hemorrhagic complications which embolization is hypothesized to prevent based on theoretical speculations but not demonstrated in practice.

scholarly journals Complication Analysis of 469 Brain Arteriovenous Malformations Treated with N-Butyl Cyanoacrylate

2005 ◽  
Vol 11 (2) ◽  
pp. 141-148 ◽  
Author(s):  
T. L. Li ◽  
B. Fang ◽  
X. Y. He ◽  
C. Z. Duan ◽  
Q. J. Wang ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Procedures ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Embolization Therapy ◽  
Brain Arteriovenous Malformations ◽  
Ischemic Complications ◽  
Brain Avms ◽  
Special Strategy ◽  
Low Rate

We independently assessed the frequency, severity and determinants of neurological deficits after endovascular embolization with NBCA of brain arteriovenous malformations (BAVMs) to have a better basis for making treatment decisions. All the charts of 469 BAVMs patients who underwent embolization with NBCA were reviewed. We analyzed the complications and their relation to angiographic features. The 469 patients were treated with 1108 endovascular procedures. Each met one to eight times, average 2.3 times. Eleven patients showed treatment-related complications, including four haemorrhagic and seven ischemic complications. Of these 11 cases, two died, two had persistent disabling deficits, and another seven suffered transient neurological deficits. Our finding suggests a low rate of disabling treatment complications for embolization of brain AVMs with NBCA in this center. The management of AVM patients who have high risk of embolization therapy should be treated by special strategy.

scholarly journals Detectability of Brain Arteriovenous Malformations with CT Angiography in the Chuvash Republic

2020 ◽  
Vol 101 (3) ◽  
pp. 163-169
Author(s):  
M. N. Mikhaylova ◽  
O. Yu. Kostrova ◽  
L. M. Merkulova ◽  
G. Yu. Struchko ◽  
A. Yu. Semenov
Keyword(s):  
High Risk ◽  
Arteriovenous Malformations ◽  
Detection Rate ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Brain Arteriovenous Malformations ◽  
Hemorrhagic Complications ◽  
Chuvash Republic ◽  
Brain Avms ◽  
Internal Carotid Arteries

Objective. To estimate the detection rate of brain arteriovenous malformations (AVMs) in the Chuvash Republic and their characteristics.Material and methods. The results of CT angiographies performed at the Unit of Radiation Diagnosis in 2014–2017 were retrospectively analyzed.Results. Over 4 years, brain AVMs were first detected in 29 patients (5–9 cases per year); of them 59% were men and 41% were women. The peak detectability occurred at the age of 31–40 years. AVMs were more frequently localized in the frontal and temporal regions. The high risk of surgery for AVMs according to the grading scheme by R. Spetzler and N. Martin (1986) occurred in 10% of cases. Besides AVMs, cerebral vascular aneurysms were detected in 14% of patients.Conclusion. Small AVMs with a low risk of surgery are more common; however, there is a higher risk of hemorrhagic complications. The risk of cerebral hemorrhage is higher when AVMs are fed by the internal carotid arteries and drained into the deep veins. The likelihood of strokes in AVMs is 27% higher in patients with the open circle of Willis.

Embolization of spinal cord arteriovenous malformations with an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx liquid embolic system)

2000 ◽  
Vol 93 (2) ◽  
pp. 304-308 ◽  
Author(s):  
Andrew J. Molyneux ◽  
Stuart C. Coley
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Promising Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Brain Avms

✓ In this paper the authors describe the first use of a new liquid embolic agent (Onyx) to treat spinal cord arteriovenous malformations (AVMs). Because its properties make it more predictable to use than currently available liquid agents, the authors believe that this material has great potential in the endovascular management of both spinal cord and brain AVMs. This very promising agent merits further clinical study.

A nonadhesive liquid embolic agent composed of ethylene vinyl alcohol copolymer and ethanol mixture for the treatment of cerebral arteriovenous malformations: experimental study

2002 ◽  
Vol 97 (4) ◽  
pp. 889-895 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Kiyoshi Kazekawa ◽  
Yasuji Ishimaru ◽  
...  
Keyword(s):  
Renal Artery ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Ethanol Mixture ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Delivery Technique ◽  
Fine Print

Object. The authors have developed a mixture of ethylene vinyl alcohol copolymer (EVAL) and iopamidol, which is dissolved in ethanol, as an alternative solvent to provide a safe means of embolizing arteriovenous malformations (AVMs). Methods. A two-stage delivery technique is required to prevent premature precipitation in the catheter when using this material: the catheter is first infused with 30% ethanol and this is followed by the delivery of the EVAL—ethanol mixture. Acute angiographic changes were analyzed after superselective delivery of dimethyl sulfoxide (DMSO) and 30% ethanol into the renal artery of rabbits. Histological changes following the embolization of the renal artery achieved using the EVAL—ethanol mixture were recorded at 1 hour and at 2 and 16 weeks after the procedure. Although DMSO always produced severe, rapidly progressive vasospasm in the renal artery during a 1- to 60-minute postinfusion, 30% ethanol did not. Microscopically, the lumens of embolized vessels examined 1 hour after embolization with EVAL—ethanol appeared to be filled with EVAL sponges, leaving almost no open spaces. The space between the EVAL sponges and the inner surface of the vessels was filled with fresh thrombus. In the vessel walls of specimens examined 2 weeks after embolization there was no or a slight inflammatory reaction. Scattered in the EVAL sponges were almost equal numbers of neutrophilic granulocytes and mononuclear cells, indicative of a mild inflammatory response. In specimens examined 16 weeks postembolization, the changes noted at 2 weeks were intensified. There was no definite histopathological evidence of mural hemorrhage, perivascular extravasation of the mixture, or perivascular hemorrhage in any specimen that was examined. Conclusions. Although the degree of permanence of this embolization material is yet unknown, the mixture was easy to handle, and appeared safe and effective for AVM embolization. Its nonadhesive characteristic and its ability to be infused by repeated injections make it an attractive alternative to currently available materials. The good results obtained in this study led us to undertake a clinical trial, the results of which are contained in a companion article in this issue of the Journal of Neurosurgery.

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