Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx)

Panagiotopoulos, Vasileios; Gizewski, Elke R.; Asgari, Siamak; Regel, Jens P.; Forsting, M.; Wanke, Isabel

doi:10.3174/ajnr.a1314

Cited by 200 publications

(109 citation statements)

References 40 publications

(49 reference statements)

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“…The nBCA is cheaper than Onyx, but Onyx permitted long injection and embolization in a more controlled manner than nBCA (8). The nBCA, which does not penetrate deeply precipitates much more quickly than Onyx, and it may cause incomplete embolization of the AVM and glue precipitation in the microcatheter (8). Besides, the risk of migration to pulmonary vessels with nBCA is higher than that with Onyx, and we prevented migration of Onyx to pulmonary vessels with slow injection of Onyx.…”

Section: Discussionmentioning

confidence: 92%

“…Earlier reports on endovascular treatment of rAVMs describe embolization with liquid embolic materials, such as acrylic glue (n-butyl-cyano-acrylate, nBCA) or ethanol (7). The nBCA is cheaper than Onyx, but Onyx permitted long injection and embolization in a more controlled manner than nBCA (8). The nBCA, which does not penetrate deeply precipitates much more quickly than Onyx, and it may cause incomplete embolization of the AVM and glue precipitation in the microcatheter (8).…”

Section: Discussionmentioning

confidence: 99%

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Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx

et al. 2016

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Renal arteriovenous malformations are rare, as is their embolization with Onyx. Endovascular curative embolization of renal arteriovenous malformations with Onyx is a relatively new procedure. Herein we present two cases of congenital and one case of acquired renal arteriovenous malformation embolized with Onyx 18 and their good results in the follow-up period. We used detachable microcatheters, which may be more advantageous than the nondetachable ones, during the superselective embolizations. Onyx, as an efficient embolic material, can be commonly used for curative embolization of the renal arteriovenous malformations.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx

et al. 2016

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“…Generally, this complication may not cause disastrous consequences. With the advent of Onyx and growing experience in embolization of cerebral arteriovenous malformations, the non-adhesive liquid embolic agent has been rapidly replacing the use of acrylic glue [1][2][3][12][13][14] . Unlike NBCA or Glubran 2, Onyx injection requires more fluoroscopy and procedure times, and it is a controllable embolic agent 15 .…”

Section: Embolization Resultsmentioning

confidence: 99%

Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

Liu

et al. 2014

Interv Neuroradiol

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The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4–65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1–12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS≤2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency.

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“…In certain cases, this may result in the breakage of the microcatheter inside the cranium. Furthermore, non-adhesive liquid embolic materials (19,20) can be used, which do not adhere to the catheter wall. These materials include CAP, EVAL, Eudragit-E and HEMA-co-MMA.…”

Section: Discussionmentioning

confidence: 99%

Experimental study of temperature-sensitive chitosan/β-glycerophosphate embolic material in embolizing the basicranial rete mirabile in swines

Ning

Zhao

Pang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the feasibility of the non-adhesive temperature-sensitive liquid embolic material, chitosan/β-glycerophosphate (C/GP), in embolizing the basicranial rete mirabile (REM) in a swine model of cerebral arteriovenous malformation (cAVM). A total of 24 domestic swines were used as the experimental animals, among which 12 pigs underwent direct embolization of one side of the REM, while the other 12 pigs underwent embolization of the bilateral REM following anastomosis of the carotid artery and jugular vein. A super-selective microcatheter was introduced into the REM during the embolization procedure, and the C/GP hydrogel was injected until an image of the REM disappeared in the angiography examination. Further angiography examinations were performed after 2 and 6 weeks, and histological examination of the REM was performed after 6 weeks. Of the 24 domestic swines, 23 cases underwent successful thrombosis. Convulsions occurred in one case and that pig died during the embolization procedure. Following embolization, the angiography observations revealed that the embolized REM was no longer able to be developed, and adhesion of the microcatheter tip with the embolic agent did not occur. In addition, no apparent revascularization was observed in the angiography examinations performed at weeks 2 and 6. Therefore, the current preliminary study indicated that use of the non-adhesive temperature-sensitive embolic material was feasible for the embolization of cAVM; thus, C/GP may be used as an ideal embolic material for the treatment of cAVM. IntroductionCerebral arteriovenous malformation (cAVM) is the major cause of intracranial hemorrhage and seizures in young and middle-aged adults, and can seriously threaten their quality of life and life expectancy (1,2). Due to the minimal harm inflicted on patients, endovascular embolization therapy has become an important method for the treatment of cAVM, and the selection of an embolic material is a major determinant towards the treatment efficacy.The ideal cAVM embolic material should have a number of characteristics. Firstly, the material should be liquid, since this enables easy control, good dispersibility and ensures a sufficient injection time. Secondly, the material should exhibit a permanent embolism effect. Finally, the material should be non-toxic. Therefore, a non-adhesive liquid embolic material is ideal. In recent years, this particular material had received considerable attention in the field of endovascular treatment (3).Therefore, the present study investigated chitosan/β-glycerophosphate (C/GP) as the base material. The C/GP solution is liquid at room temperature, but forms a hydrogel at 37.0˚C (body temperature). In addition, the pH of the C/GP solution is compatible with the physiological requests. These two materials have been previously demonstrated to be safe and non-toxic (4); however, the combination of C/GP has not been utilized in previous studies as a non-adhesive temperature-sensitive liquid embolic mat...

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Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx)

Cited by 200 publications

References 40 publications

Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx

Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx

Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

Experimental study of temperature-sensitive chitosan/β-glycerophosphate embolic material in embolizing the basicranial rete mirabile in swines

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