Endovascular treatment of intracranial arteriovenous malformations using detachable-tip microcatheters and Onyx 18®

Özpar, Rıfat; Nas, Ömer Fatih; Hacıkurt, Kadir; Taşkapılıoğlu, Mevlüt Özgür; Kocaelı, Hasan; Hakyemez, Bahattin

doi:10.1016/j.diii.2019.01.009

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…Through a systematical literature search, a total of 3892 potentially relevant studies were identified. After duplication-checking, title and abstract screening, and full-text review, 28 full-text studies [1–3,5,7,11,16–37] including 5852 patients were included in the final analysis. The characteristics of the included studies were summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Treatments of unruptured brain arteriovenous malformations

et al. 2021

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Background: The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed. Objective: To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments. Methods: A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis. Results: We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%–99%, I 2 = 74.5%), 97% in surgery group (95%CI: 95%–99%, I 2 = 18.3%), 87% in endovascular treatment group (95%CI: 80%–93%, I 2 = 0.0%), and 68% in radiosurgery group (95%CI: 66%–69%, I 2 = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%–2%, I 2 = 0.0%), 0% in surgery group (95%CI: 0%–1%, I 2 = 0.0%), 4% in endovascular treatment group (95%CI: 0%–8%, I 2 = 85.8%), and 3% in radiosurgery group (95%CI: 3%–4%, I 2 = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%–4%, I 2 = 0.0%), 23% in endovascular treatment group (95%CI: 7%–39%), and 12% in radiosurgery group (95%CI: 12%–13%, I 2 = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%–11%, I 2 = 94.1%), 20% in surgery group (95%CI: 13%–27%, I 2 = 0.0%), 14% in endovascular treatment group (95%CI: 10%–18%, I 2 = 64.0%), and 8% in radiosurgery group (95%CI: 7%–9%, I 2 = 66.6%). Conclusions: We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.

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Section: Resultsmentioning

confidence: 99%

Treatments of unruptured brain arteriovenous malformations

et al. 2021

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“…The most frequently used detachable tip microcatheters are Sonic (Balt) and Apollo (Medtronic). Using detachable tip microcatheters, reflux of LEA up to the detachment site can be tolerated, and the microcatheter can be removed from the body, while the detached tip stays within the embolized blood vessel [14,[40][41][42][43]. For all kinds of microcatheters (detachable tip or nondetachable tip) retrieval of the microcatheter is usually performed by slowly pulling it for a distance of a few centimeters, while aspirating on the catheter using a syringe.…”

Section: Embolic Propertiesmentioning

confidence: 99%

Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

et al. 2021

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Background Endovascular embolization is an effective treatment option for cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). A variety of liquid embolic agents have been and are currently used for embolization of AVMs and DAVFs. Knowledge of the special properties of the agent which is used is crucial for an effective and safe embolization procedure. Material and Methods This article describes the properties and indications of the liquid embolic agents which are currently available: cyanoacrylates (also called glues), and the copolymers Onyx, Squid and PHIL, as well as their respective subtypes. Results Cyanoacrylates were the predominantly used agents in the 1980s and 1990s. They are currently still used in specific situations, for example for the occlusion of macro-shunts, for the pressure cooker technique or in cases in which microcatheters are used that are not compatible with dimethyl-sulfoxide. The first broadly used copolymer-based embolic agent Onyx benefits from a large amount of available experience and data, which demonstrated its safety and efficacy in the treatment of cerebral vascular malformations, while its drawbacks include temporary loss of visibility during longer injections and artifacts in cross-sectional imaging. The more recently introduced agents Squid and PHIL aim to overcome these shortcomings and to improve the success rate of endovascular embolization. Novelties of these newer agents with potential advantages include extra-low viscosity versions, more stable visibility, and a lower degree of imaging artifacts. Conclusion All the available liquid embolic agents feature specific potential advantages and disadvantages over each other. The choice of the most appropriate embolic agent must be made based on the specific material characteristics of the agent, related to the specific anatomical characteristics of the target pathology.

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“…Of note, one patient died because of extensive hepatic necrosis despite no alterations in portal perfusion [ 32 ]. Other embolic agents, such as ethylene vinyl alcohol copolymer (Onyx ® , EV3, Irvine, CA, USA) are available for embolization, but their use has not been reported for TAE and TACE [ 33 ].…”

Section: Transarterial Embolization and Transarterial Chemoembolizmentioning

confidence: 99%

The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review

Barat

Cottereau

Kedra

et al. 2020

JCM

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Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.

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Endovascular treatment of intracranial arteriovenous malformations using detachable-tip microcatheters and Onyx 18®

Cited by 9 publications

References 16 publications

Treatments of unruptured brain arteriovenous malformations

Treatments of unruptured brain arteriovenous malformations

Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review

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