Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature

Gioppo, Andrea; Faragò, Giuseppe; Caldiera, Valentina; Caputi, Luigi; Cusin, Alberto; Ciceri, Elisa

doi:10.1016/j.wneu.2017.08.050

Cited by 27 publications

(32 citation statements)

References 23 publications

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“…9 The goal of endovascular therapy is to occlude the shunt point by a transarterial approach, a transvenous approach or a combination of both. 10 Over the years, different embolic agents have been used for the endovascular approach, including polyvinyl alcohol particles, platinum micro-coils and n-butyl cyanoacrylate (NBCA). In recent years, nonadhesive LEAs have become the gold standard for endovascular embolization of cDAVF, because of the slower precipitation time that allows for deeper penetration and more controlled injection of the agent.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

et al. 2020

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Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

et al. 2020

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“…Squid is an ethylene vinyl alcohol copolymer available in two versions: Squid 12 and Squid 18. Squid has 30% less tantalum than Onyx and has micronised tantalum, which may help better visualise structures behind the embolised material and provide a more homogeneous solution than Onyx 13 30. Akmangit and colleagues reported a case series of using Squid to treat nine dAVFs with Sonic (Balt, Montmorency, France), another detachable microcatheter delivery system 13.…”

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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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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“…Squid-18, such as in case of Onyx use, is suggested for initial plug formation, while the new formulation Squid-12 can improve vascular penetration and spread more distally. Another advantage of Squid over Onyx is related to the reduced percentage (30%) of tantalum which can improve vessels visualization during embolization and limit metallic artifacts at imaging follow-up (Gioppo et al, 2017), as also recently demonstrated (Pop et al, 2018). Squid was always administered using DMSO-compatible coaxial microcatheters as straight Renegade Hi-flo (Boston) or curved Carnelian (Tokai): the peculiar cobra-shaped tip of Carnelian was useful in selected cases of marked tortuosity of the target artery, as for example in VAA (splenic) or type 2 endoleak embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Onyx, first described in 1990s, represents the well-known liquid embolic agent widely used in cerebral arteriovenous malformations (AVMs) (Gemmete et al, 2009;Singfer et al, 2017;Alturki et al, 2018;Nerva et al, 2018) and also in abdominal-peripheral applications (Cobb et al, 2014;Né et al, 2018;Izaaryene et al, 2016;Regine et al, 2015;Chevallier et al, 2016), particularly in the management of endoleak post Endovascular Aortic Repair (EVAR) (Marcelin et al, 2017;Ierardi et al, 2018). Squid is a new DMSO-and EVOH-based liquid embolic agent which has mainly been used in cerebral field (Akmangit et al, 2017;Gioppo et al, 2017) with poor application in abdominal district (Szatmáry et al, 2017). It is commercially available in Squid-12 (Szatmáry et al, 2017;Erbahceci et al, 2014) and Squid-18 forms.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

et al. 2019

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Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases. Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved. Conclusion:Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

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Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature

Cited by 27 publications

References 23 publications

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

Updates in the management of cranial dural arteriovenous fistula

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

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