Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx

Liu, L; Jiang, Chuhan; He, Hong; Li, Y; Wu, Zhongxue

doi:10.1177/159101991001600106

Cited by 20 publications

(10 citation statements)

References 25 publications

(54 reference statements)

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“…Among them hemorrhage is the most common and potentially devastating complication, that plays a significant role in clinical course and long-term prognosis. 4–6…”

Section: Introductionmentioning

confidence: 99%

Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire

Orlov¹,

Panarin²,

Кривошапкин³

et al. 2015

Interv Neuroradiol

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Endovascular embolization is an important modality in the treatment of brain AVMs. Nowadays staged embolization is the method of choice for the prevention of perioperative hemorrhagic complications. Current theory suggests that simultaneous occlusion of more than 60% of AVM volume induces significant redistribution local blood flow. That, in turn, may lead to hemorrhage due to AVM rupture. Aside from angiographic findings, there is still no method that predicts the degree of safe partial embolization. Intraluminal measurement of flow velocity and pressure in the vicinity of the AVM nidus might allow detecting the changes in local hemodynamics. That can provide a valuable data and shed the light on the origin of vascular catastrophes. Ten patients underwent 12 embolization sessions with intraluminal flow velocity and pressure monitoring. The measurements were performed by dual-sensor guidewire. The “Combomap” (Volcano) system with Combowire microguidewires was chosen for measurements, as there is a documented experience of safe use of said guidewires in the cerebral vasculature. The findings observed during the study matched empirical data as well as the current physiological hypothesis of AVM hemorrhage. In conjunction with DSA runs, intraluminal flow velocity and pressure monitoring has the potential to become a valuable tool in AVM treatment.

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“…Among them hemorrhage is the most common and potentially devastating complication, that plays a significant role in clinical course and long-term prognosis. 4–6…”

Section: Introductionmentioning

confidence: 99%

Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire

Orlov¹,

Panarin²,

Кривошапкин³

et al. 2015

Interv Neuroradiol

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“…and most of them resolved over time 11 . Clinically apparent complications were found to be more frequent in case of deep venous drainage, high Spetzler grade and periprocedural bleedings 12,13 and also to depend on the number of feeders embolized 14 .…”

Section: Resultsmentioning

confidence: 97%

Unexpected Silent Infarctions after Embolization of Cerebral Arteriovenous Malformations and Fistulas

et al. 2013

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We investigated the number and possible causes of clinically silent lesions seen in diffusion-weighted magnetic resonance imaging after embolization of arteriovenous malformations (AVMs) and fistulas using acrylate only or in combination with coils. Included were 19 patients with 18 AVMs and one case of a vein of Galen aneurysm in which 25 interventions were carried out. Results of diffusion-weighted imaging, the appearance of perinidal and distant lesions, were correlated to Spetzler grade, nidus size, flow, number of feeders occluded, rate of nidus occlusion and duration of the intervention. We found seven distant lesions corresponding to non-symptomatic infarcts in the given clinical setting. The only significant correlation between lesion size and parameters analyzed was the degree of nidus occlusion achieved during the intervention. Because most of the lesions presented in cases with a high occlusion rate, they appear to be related to the intention to reach a complete occlusion of the nidus. These results emphasize that the risk involved in eliminating the nidus completely must be reconsidered with special care, particularly in a situation where most high-flow feeders have been occluded.

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“…This technique is highly effective and was reported back with great success for catheter entrapment. 10 Another technique was the ''over-the-catheter'' technique which utilizes another catheter that is placed over the trapped microcatheter. In that study, the author used an Outreach distal access catheter, putting it over the Marathon microcatheter, and positioned adjacently to the proximal cast.…”

Section: Resultsmentioning

confidence: 99%

“…9 Retrieval of the retained microcatheter can be daunting and many techniques have been ascribed in managing this complication like the “over-the-catheter” and the “monorail snare” technique. 7,10,11…”

Section: Introductionmentioning

confidence: 99%

“…9 Retrieval of the retained microcatheter can be daunting and many techniques have been ascribed in managing this complication like the ''over-the-catheter'' and the ''monorail snare'' technique. 7,10,11 In this paper, we would like to add the ''pull-pushpull'' technique to the repository of management techniques of an entrapped microcatheter after Onyx embolization. Our experiences with this novel technique in BAVM embolization have been favorable and cost-effective.…”

Section: Introductionmentioning

confidence: 99%

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Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note

Grigorian²

2015

Interv Neuroradiol

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Objective Many techniques have been use for retrieval of an entrapped microcatheter during Onyx (eV3 Neurovascular) embolization of brain arteriovenous malformations (BAVMs). We report our technique that we term “pull-push-pull” that can be utilized as first management in retrieving the microcatheter. Method We analyzed a total of 37 patients that underwent BAVM embolization with either Onyx 18 or 34 at our institution. Standard embolization techniques were utilized with the use of Marathon (eV3 Neurovascular) microcatheter. When difficulty in retrieving the microcatheter arose, we used the “pull-push-pull” technique. The technique comprises the eV3 protocol of retraction. In addition, the microcatheter is stretched causing the Onyx cast to stretch in its inner core, creating a more thorough cohesive property amongst the Onyx mixture. Then the microcatheter is pushed back and to its point of embolization origin. Afterwards, retraction of the microcatheter is enabled as it can be easily dislodged from the cast. Multiple attempts can be repeated as needed. Result and discussion We had three patients that had difficulty with removal of microcatheter (8.1%). Utilization of the “pull-push-pull” technique was used on two of those patients. No neurological complication was observed with our technique. We believe the cohesive property of Onyx solution helps in the retrieval of the catheter by our method and technique. Conclusion We believe the “pull-push-pull” can be utilized and be an additional technique before attempting other catheter retrieval techniques in Onyx BAVM embolization.

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Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx

Cited by 20 publications

References 25 publications

Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire

Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire

Unexpected Silent Infarctions after Embolization of Cerebral Arteriovenous Malformations and Fistulas

Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note

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