Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study

Lamin, Saleh; Chew, Han Shi Jocelyn; Chavda, Swarupsinh; Thomas, Ajith J.; Piano, Mariangela; Quilici, Luca; Pero, Guglielmo; Holtmannspolter, M.; Cronqvist, M.; Casasco, A.; Guimaraens, Léopoldo; Paúl, Laura; García, A. López; Aleu, Aitzíber; Chapot, René

doi:10.3174/ajnr.a5037

Cited by 37 publications

(34 citation statements)

References 13 publications

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“…Although in the past, detachable balloons, polyvinyl alcohol, silk sutures and microspheres were used for treatment of cerebral AVM and dAVFs they have been widely replaced by current embolic agents, including n -butyl-2-cyanoacrylate ( n -BCA, glue, Trufill, DePuy Synthes, Raynham, MA), Onyx (ev3 Endovascular, Irvine, CA), Squid (Emboflu, Switzerland), precipitating hydrophobic injectable liquid (PHIL; MicroVention, Aliso Viejo, California) and detachable microcoils. Recent advancements have introduced newer embolic agents, such as PHIL12 and Squid (Emboflu),13 and flow diverters, such as the pipeline embolisation device (Medtronic Neurovascular, Irvine, California), to treat AVFs and inhibit fistula recanalisation in special scenarios,14 as described by Castãno et al with the treatment of two Barrow type B indirect carotid cavernous fistula (CCF), a version of dAVF. Classic approaches described for endovascular treatment of dAVFs include transarterial, transvenous or a combination of both techniques.…”

Section: Endovascular Approachmentioning

confidence: 99%

“…Leyon and colleagues described using PHIL in eight cases to treat five cranial and three spinal dAVFs with either Apollo (Medtronic) or Marathon (Medtronic) microcatheter delivery systems 29. Lamin and colleagues are also reported using PHIL in 30 procedures with Apollo, Marathon or Headway Duo (MicroVention) microcatheter delivery systems 12…”

Section: Transarterial Embolisationmentioning

confidence: 99%

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Updates in the management of cranial dural arteriovenous fistula

Baharvahdat

Ooi²,

Kim

et al. 2019

Stroke Vasc Neurol

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Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.

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Section: Endovascular Approachmentioning

confidence: 99%

Section: Transarterial Embolisationmentioning

confidence: 99%

Updates in the management of cranial dural arteriovenous fistula

Baharvahdat

Ooi²,

Kim

et al. 2019

Stroke Vasc Neurol

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show abstract

“…Moreover, patients treated with Onyx-18 tended to have lower complication rates compared with that of histoacryl. There are initial but promising reports regarding Phil, and its safety and efficacy is yet to be evaluated in future studies [21]. We utilised it in one case of a type I fistula and achieved closure on angiography (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas

et al. 2019

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Introduction There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman’s rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat ( r = 0.59, p < 0.05), as well as the volume of contrast used ( r = 0.77, p < 0.05). Infratentorial ( r = 0.53, p < 0.05) and right-sided ( r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome ( r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows ( p = 0.459) and largest outflow diameter ( p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died – one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation-related complications. Conclusions To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial.

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“…The non-adhesive nature of this agent affords potential for longer injection times as well as the capacity to perform control angiography mid-procedure. Its preference as an embolic agent in the management of cerebral AVMs and dural arteriovenous fistulae is increasing (Koçer et al, 2016a;Samaniego et al, 2016;Lamin et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report

et al. 2019

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Objective: Uterine arteriovenous malformations (AVM) are unusual causes of vaginal bleeding. Although hysterectomy is the definitive treatment; uterine artery embolization (UAE) provides an alternative therapeutic option. This case presents a technical report of a uterine AVM treated successfully with transcatheter UAE using precipitating hydrophobic injectable liquid (PHIL) embolic agent. Case report: A 41-year-old female, gravida 6, para 4, miscarriage 2, including a molar pregnancy 15 years prior, presented with massive per vaginal bleeding. Pelvic ultrasound demonstrated an acquired AVM as the underlying aetiology for her presentation. The patient underwent bilateral uterine arterial embolization. Four weeks later, there was nearly complete resolution of the AVM and the patient's menstrual cycle was restored 8 weeks after the procedure. Conclusion: Uterine AVM can be treated safely and effectively with UAE using PHIL.

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Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study

Cited by 37 publications

References 13 publications

Updates in the management of cranial dural arteriovenous fistula

Updates in the management of cranial dural arteriovenous fistula

Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas

Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report

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