title: Comparison of N-butyl cyanoacrylate and onyx for the embolization of intracranial arteriovenous malformations: analysis of fluoroscopy and procedure times.
abstract: OBJECTIVE
  Intracranial arteriovenous malformations (AVM) may be managed through staged preoperative embolization and resection. Two commonly used liquid embolics are N-butyl cyanoacrylate (nBCA; Cordis Microvascular, Inc., New Brunswick, NJ) and Onyx (ev3, Inc., Irvine, CA). We sought to compare the utility of these agents in terms of fluoroscopy and procedure times.
  
  
  METHODS
  All intracranial AVMs embolized from 2002 to 2006 at the University of Florida were included in this study. Patients were stratified into three treatment groups: nBCA, Onyx, and patients who received both nBCA and Onyx during separate embolizations. Cohorts were compared by sex, age, Spetzler-Martin grade, AVM volume, fluoroscopy time, procedure time, surgical blood loss, and complications.
  
  
  RESULTS
  A total of 182 embolizations were performed on 88 patients (nBCA, 60 patients and 106 procedures; Onyx, 20 patients and 43 procedures; and nBCA/Onyx, eight patients and 16 nBCA and 17 Onyx procedures). There were no significant differences in patient demographics, AVM volumes, and Spetzler-Martin grades. Mean fluoroscopy and procedure times were increased for Onyx (57 min; 2.6 h) compared with nBCA (37 min; 2.1 h) embolizations (P < 0.0001 and P = 0.001, respectively). Cumulative mean fluoroscopy time was increased for Onyx (135 min) and nBCA/Onyx (180 min) cohorts relative to nBCA (64 min; P < 0.0001). Cumulative mean procedure time was increased in the nBCA/Onyx group (10.4 h) compared with nBCA (3.7 h) and Onyx (5.4 h; P < 0.0001). Seventy patients (80%) underwent AVM resection. No significant differences in surgical blood loss or complication rates were observed among the cohorts.
  
  
  CONCLUSIONS
  Onyx AVM embolization requires increased fluoroscopy and procedure times compared with nBCA. Further investigation is necessary to justify increased radiation exposure and procedure time associated with Onyx.
authors: Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610, USA. gregory.velat@neurosurgery.ufl.edu
authors: Gregory J
authors: GJ
authors: Velat
authors: John F
authors: JF
authors: Reavey-Cantwell
authors: Christopher
authors: C
authors: Sistrom
authors: David
authors: D
authors: Smullen
authors: Gregory L
authors: GL
authors: Fautheree
authors: Jobyna
authors: J
authors: Whiting
authors: Stephen B
authors: SB
authors: Lewis
authors: Robert A
authors: RA
authors: Mericle
authors: Christopher S
authors: CS
authors: Firment
authors: Brian L
authors: BL
authors: Hoh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage* / Q000737:chemistry; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage* / Q000737:chemistry; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage* / Q000737:chemistry; D011446:Prospective Studies; D013997:Time Factors
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004659:Enbucrilate; D004121:Dimethyl Sulfoxide