Onyx embolization of carotid-cavernous fistulas

Abstract

Onyx is a liquid embolic agent that is effective in the treatment of CCFs but not without hazards. Postembolization cavernous sinus thrombosis and swelling may result in transient compressive cranial neuropathies. The inherent gradual polymerization properties of Onyx allow for casting of the cavernous sinus but may potentially result in deep penetration within arterial collaterals that can cause CN ischemia/infarction. Although not proven, the angiotoxic effects of dimethyl sulfoxide may also play a role in postembolization CN deficits.

Use of Onyx for Transarterial Balloon-Assisted Embolization of Traumatic Carotid Cavernous Fistulas: A Report of 23 Cases

“…The use of Onyx as the sole embolic agent for TCCFs has been rarely reported. 1,2 In this article, we report our preliminary experience of the use of Onyx for TCCFs in 23 patients.…”

Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: case series and technical note

“…Additionally, when using Onyx through a transvenous route, a balloon can protect the ICA from inadvertent embolization into the intracranial circulation. 5 We prefer an elongated conformal balloon (Hyperglide) rather than the highly conformal but shorter balloon (Hyperform, Inc.) that was used by Elhammady et al 5 In fact, the Hyperglide balloon covers a longer segment, which allows better identification of the carotid artery during the course of embolization.…”

“…7 Balloon assistance during embolization of CCFs was used by Zenteno et al 10 and Elhammady et al 5 to increase microcatheter purchase and avoid reflux of the embolic material into the arterial circulation. However, these authors did not use the balloon for identification of the fistulous site or demarcation of the ICA during embolization.…”

“…9 The use of a nondetachable balloon during Onyx embolization (ev3, Inc.) of CCFs has been reported in 2 recently published articles, but the utility and the safety of the technique have not been investigated. 5,10 We present a series of 5 cases in which a direct or type A CCF 2 was treated using a transvenous or transarterial approach with simultaneous protection of the ICA with a nondetachable compliant balloon. We describe this technique and assess its feasibility, safety, and utility.…”

Endovascular Approaches to the Carotid Cavernous Sinus for Endovascular Treatment of Carotid Cavernous Fistulas and Hormone Sampling

“…Onyx-is a newly developed liquid embolic agent, effective in the treatment of CCFs but not without hazards 50 . Particles may be safer than liquid emboli and in our series of TAE using only particles, no complications occurred.…”