Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience

Abstract

BackgroundDural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen.Methods and resultsWe present six cases in which the double-lumen balloon microcatheter was used to transarterially embolize dural arteriovenous fistulas via injection of Onyx through the wire lumen. Depending on the individual pathology a venous balloon was also used in some cases. The advantages and disadvantages of the use of these devices are discussed.ConclusionsWe consider that the use of the double-lumen balloon technique for fistula embolization has the potential for reducing overall procedural times, procedural failures and catheter retention in certain situations. In such cases we would advocate this as a first-line technique. When lower profile, more navigable balloon catheters become available, this may become the standard of care.

Endovascular Treatment of Dural Arteriovenous Fistulas of the Transverse and Sigmoid Sinuses Using Transarterial Balloon-Assisted Embolization Combined with Transvenous Balloon Protection of the Venous Sinus

“…[1][2][3][4][5][6][7][8][9]16 In the largest study available, Kim et al 5 compared the results of transarterial Onyx embolization for dAVFs using a double-lumen balloon with those obtained by using a nonballoon microcatheter. The use of a doublelumen balloon microcatheter led to an increased immediate complete occlusion rate, decreased procedure time, decreased Onyx injection time, and a decrease in the number of feeders requiring embolization compared with the group treated with a nonballoon microcatheter.…”

“…These studies have reported high occlusion rates, reduction of reflux into the feeding artery, a reduced quantity of injected Onyx and peri-interventional time, and low complication rates. [1][2][3][4][5][6][7][8][9] In addition, transvenous balloon-assisted sinus protection during transarterial embolization has been reported to be another useful adjunct to the endovascular treatment of dAVFs. [10][11][12] Transvenous balloon protection of the recipient sinus has mainly been associated with a reduction in inadvertent occlusion of the lumen of a functioning sinus, preservation of venous patency, facilitation of occlusion of abnormal arteriovenous connections within the sinus wall and separate venous channels, and increased penetration of embolic material by retrograde reflux into other dural feeders of the fistula network.…”

Balloon-assisted microcatheter navigation for AVM embolization: technical note

“…6,14 As in microsurgery, the temporary arrest of the blood flow with a balloon is well tolerated, particularly when performed for a short time 13,18 Even though much has been written about the multipurpose use of balloons in neurointerventional procedures, 3,6,10,14 no report has addressed the use of a nondetachable balloon to support microcatheter navigation in AVM embolizations.…”

The Treatment Outcome of Transarterial Embolization for Isolated Sinus Type Dural Arteriovenous Fistula between NBCA and Onyx

“…In addition, the risk of gluing of a microcatheter can be reduced compared with the use of a usual microcatheter. 19,20) Although TAE using Onyx still remains outside insurance coverage in Japan, it is considered a useful technique.…”