Flow control techniques for Onyx embolization of intracranial dural arteriovenous fistulae
Zhong-Song Shi1,2,
Yince Loh2,3,
Nestor Gonzalez2,
Satoshi Tateshima2,
Lei Feng2,4,
Reza Jahan2,
Gary Duckwiler2,
Fernando Viñuela2
1Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
2Division of Interventional Neuroradiology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
3Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
4Department of Diagnostic Imaging, Kaiser Permanent Medical Center, Los Angeles, California, USA
Correspondence to Dr Z-S Shi, Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; zhongsongshi{at}gmail.com
Objectives Experience of flow control techniques during endovascular treatment of intracranial dural arteriovenous fistulas (DAVFs) using the Onyx liquid embolic system is reported, with an emphasis on high flow shunts.
Methods Data were evaluated in patients with DAVFs treated endovascularly with Onyx. Adjunctive techniques with coils, acrylics and balloon assistance were utilized to reduce the rate of flow with transarterial and transvenous approaches.
Results The following types of adjunctive techniques were used in 58 patients who underwent a total of 84 embolization sessions with Onyx: transvenous coiling with transvenous or transarterial Onyx embolization in 36 patients, transarterial coiling with transarterial Onyx embolization in eight patients, arterial or venous balloon assisted technique with transarterial or transvenous Onyx embolization in 11 patients, transarterial high concentration acrylics with transarterial Onyx embolization in one patient and staged transarterial or transvenous coiling and Onyx embolization in two patients. Complete obliteration of the fistulae was achieved in 41 patients (70.7%) and 27 patients (65.9%) with high flow fistulae after endovascular treatment alone. Periprocedural complications were encountered in 16 patients, and 13 complications were associated with the adjunctive techniques. There were four neurologic and two non-neurologic clinical sequelae. Distal Onyx migration occurred in four, microcatheter retention in three and cranial neuropathy in three patients. There was one instance each of cerebellar hemorrhage, thromboembolism, coil stretching and retention, and dissection. 56 survivors experienced complete resolution or significant improvement of their symptoms on follow-up.
Conclusions Flow control techniques are safe and effective adjunctive methods in primary endovascular Onyx embolization of high flow DAVFs.
http://dx.doi.org/10.1136/neurintsurg-2012-010303
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Z-SS is supported by the Program for New Century Excellent Talents in University of China (NCET2011), National Natural Science Foundation of China (81070949) and Fundamental Research Funds for Central Universities, Sun Yat-sen University (09ykpy38).
Competing interests GD is a paid consultant for ev3 Inc.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the local institutional review board at UCLA Medical Center.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions