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Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1959v1 31/5/947 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Maimon, S. Articles by Ram, Z. PubMed PubMed Citation Articles by Maimon, S. Articles by Ram, Z. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:947-954, May 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results S. Maimon a ,b , I. Strauss a , V. Frolov a ,b , N. Margalit a and Z. Ram a a From the Department of Neurosurgery (S.M., I.S., V.F., N.M., Z.R.) b Unit of Interventional Neuroradiology (S.M., V.F.), Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel. Please address correspondence to Dr. Shimon Maimon, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel; e-mail: shimonm@tasmc.health.gov.il BACKGROUND AND PURPOSE: Endovascular embolization with Onyx is one of the tools used in the treatment of intracerebral AVMs. The recent introduction of a new microcatheter with detachable tip has led us to adopt a new treatment approach by using endovascular embolization with Onyx as the main treatment for brain AVM with curative intent. The purpose of the present study is to evaluate our initial results by using this new treatment strategy with special emphasis on the safety and feasibility of the technique. MATERIALS AND METHODS: Forty-three consecutive patients were treated by embolization for brain AVM over a 14-month period, mostly by using Onyx and a microcatheter with detachable tip. Twenty-six of these patients (60%) harbored Spetzler-Martin AVMs of grades 4–5. RESULTS: Endovascular treatments were completed in 29 out of 43 patients; the median number of procedures per patient was 2 (range, 1–4). Complete obliteration by using embolization exclusively was achieved in 16 patients, resulting in a 55% cure rate in patients who concluded treatments (16/29) and 37% in the cohort (16/43). The amount of Onyx injected by using microcatheters with detachable tips was significantly larger than that injected with the nondetachable microcatheters (mean volume, 2.5 ± 2.2 versus 1.7 ± 1.3 mL, respectively, P < .05, t test). Seven clinical complications were observed in a total of 76 embolization sessions (9.2%). CONCLUSIONS: Endovascular embolization of brain AVM by using Onyx and SONIC results in a relatively high complete obliteration. The use of the microcatheter with detachable tip adds several advantages, mainly in that higher volumes of Onyx can be safely injected. Abbreviations: AVM, arteriovenous malformation • DMSO, dimethyl-sulfoxide • ICA, internal carotid artery • MRA, MR angiography • n -BCA, n -butyl cyanoacrylate • S-M, Spetzler-Martin Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1959
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1959v1 31/5/947 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Maimon, S. Articles by Ram, Z. PubMed PubMed Citation Articles by Maimon, S. Articles by Ram, Z. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:947-954, May 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results S. Maimon a ,b , I. Strauss a , V. Frolov a ,b , N. Margalit a and Z. Ram a a From the Department of Neurosurgery (S.M., I.S., V.F., N.M., Z.R.) b Unit of Interventional Neuroradiology (S.M., V.F.), Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel. Please address correspondence to Dr. Shimon Maimon, Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel; e-mail: shimonm@tasmc.health.gov.il BACKGROUND AND PURPOSE: Endovascular embolization with Onyx is one of the tools used in the treatment of intracerebral AVMs. The recent introduction of a new microcatheter with detachable tip has led us to adopt a new treatment approach by using endovascular embolization with Onyx as the main treatment for brain AVM with curative intent. The purpose of the present study is to evaluate our initial results by using this new treatment strategy with special emphasis on the safety and feasibility of the technique. MATERIALS AND METHODS: Forty-three consecutive patients were treated by embolization for brain AVM over a 14-month period, mostly by using Onyx and a microcatheter with detachable tip. Twenty-six of these patients (60%) harbored Spetzler-Martin AVMs of grades 4–5. RESULTS: Endovascular treatments were completed in 29 out of 43 patients; the median number of procedures per patient was 2 (range, 1–4). Complete obliteration by using embolization exclusively was achieved in 16 patients, resulting in a 55% cure rate in patients who concluded treatments (16/29) and 37% in the cohort (16/43). The amount of Onyx injected by using microcatheters with detachable tips was significantly larger than that injected with the nondetachable microcatheters (mean volume, 2.5 ± 2.2 versus 1.7 ± 1.3 mL, respectively, P < .05, t test). Seven clinical complications were observed in a total of 76 embolization sessions (9.2%). CONCLUSIONS: Endovascular embolization of brain AVM by using Onyx and SONIC results in a relatively high complete obliteration. The use of the microcatheter with detachable tip adds several advantages, mainly in that higher volumes of Onyx can be safely injected. Abbreviations: AVM, arteriovenous malformation • DMSO, dimethyl-sulfoxide • ICA, internal carotid artery • MRA, MR angiography • n -BCA, n -butyl cyanoacrylate • S-M, Spetzler-Martin Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: May 1, 2010

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