Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine.
OBJECTIVE
There have been significant improvements in neurovascular technology and implants over the past decade. One such material, N-butyl cyanoacrylate (NBCA), is now commercially available for cerebral arteriovenous malformation (AVM) embolization in the US. An ethylene vinyl alcohol copolymer preparation, Onyx, which is currently being evaluated, is approved for use outside North America. Although reports indicate that Onyx may be superior to NBCA from an endovascular perspective, little information exists about its surgical handling characteristics. The purpose of this study was to compare the surgical handling characteristics of Onyx-treated vessels with those of NBCA-embolized vessels in an AVM resection model.


METHODS
Fourteen pigs (two groups of seven) were anesthetized. A femoral artery was cannulated, followed by selective catheterization of the ascending pharyngeal arteries. Nidal rete mirabile (RM) embolizations were performed using either 6% Onyx or 20% NBCA. After angiographically confirmed obliteration of flow in the right RM, microsurgical resection of this structure was performed. Surgical handling characteristics of the embolized RM were rated on a scale of 1 to 5 and blood loss was recorded. Different surgeons performed the embolizations and resections. The surgeon who performed resections was blinded to the embolization agent used, and the data analysis was also performed in a blinded fashion. The surgical handling scores were superior (p < 0.05) in the Onyx-treated group. Although there was also less blood loss in this group, the difference was not significant. Subjectively, the surgeon who performed the resections believed that Onyx was softer and handled better than NBCA.


CONCLUSIONS
Onyx, which may offer endovascular advantages, also seems to provide benefits for the surgeon.
Akin
Eric D
ED
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Perkins
Eddie
E
Ross
Ian B
IB
D000818:Animals; D001158:Arteries / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002339:Carotid Arteries / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000627:therapeutic use*; D005263:Femoral Artery / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D008297:Male; D010614:Pharynx / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D011145:Polyvinyls / Q000627:therapeutic use*; D011859:Radiography; D013048:Specimen Handling; D013552:Swine
C450660:Onyx copolymer; D011145:Polyvinyls; D004659:Enbucrilate; D004121:Dimethyl Sulfoxide