Onyx^®: a unique neuroembolic agent

Abstract

Rupture of a cerebral arteriovenous malformation can result in devastating hemorrhage with a possibility of serious neurological injury or death. Endovascular embolization is an important adjunct in the treatment of cerebral arteriovenous malformations, and in a small number of cases may provide definitive treatment. Currently available embolic agents have several shortcomings, including the possibility of recanalization, adhesiveness to the endovascular microcatheter and suboptimal handling at the time of surgical resection. Onyx is an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide that was approved by the US FDA in July 2005 as an embolic agent for brain arteriovenous malformations. Although long-term follow-up is limited, this agent appears to offer several advantages over the other available embolic agents for the endovascular management of arteriovenous malformations and other vascular lesions.

Preparation, characterization, and evaluation of radiopaque hydrogel filaments for endovascular embolization

“…21 Several radiopaque, polymer liquid embolics have been evaluated for the treatment of vascular lesions, including poly(vinyl alcohol) containing iodine, 22 cyanoacrylates containing tantalum, 23 and ethylene vinyl alcohol copolymer containing tantalum. 24 We are not aware of any reports in the literature with the development or evaluation of metal-free, radiopaque, polymeric embolic devices.…”

Preclinical Evaluation of the NeVaTM Stent Retriever: Safety and Efficacy in the Swine Thrombectomy Model

“…Onyx is an ethylene vinyl alcohol copolymer (EVAC) dissolved in dimethyl sulfoxide approved by the US FDA for brain arteriovenous malformations [10]. The viscosity units are compared to water, where the Onyx® 18 is 18 times more viscous than water [10]. EVAC emboli were prepared as follows: Onyx® 18 or 500 was agitated in a shaker as per the manufacturer’s guidelines for 30–45 min prior to the preparation of the emboli.…”

First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease

“…They have been used as hemodialysis and apheresis membranes 18 and, more recently, have been formulated with dimethyl sulfoxide for use as embolic treatment for intracerebral aneurysms and arteriovenous malformations. 19 The STRIDES study is notable in that it represents the first clinical experience with EVAL as a polymer for intravascular drug elution. Other everolimus-eluting stents, most notable the Xience V device (Abbott), employ a fluorinated polymer drug carrier, poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) to control drug release.…”