Treatment of brain arteriovenous malformations by double arterial catheterization with simultaneous injection of Onyx: retrospective series of 17 patients.
OBJECTIVE
The use of Onyx in the treatment of intracranial AVMs has increased the cure rate of endovascular embolization compared with the use of liquid adhesive agents. Inadvertent occlusion of the draining veins before the complete exclusion of the nidus constitutes a major risk of bleeding. We report a case series using the technique of double simultaneous arterial catheterization as an approach to achieve the complete exclusion of the nidus before reaching the venous drainage, through a more controlled hemodynamic filling.


METHODS
Between April 2008 and November 2009, 17 patients with brain AVMs were treated by the DACT. The mean age of the patients was 32.7 years (range, 6-54 years), with 9 females and 8 males. The clinical onset was characterized by intracranial hemorrhage in 8 patients and by seizures in 7. The size of the AVMs ranged from 13 to 54 mm (average, 26.2 mm). The DACT was always used with the objective of curing the AVM.


RESULTS
All 17 patients completed the EVT. The average number of sessions conducted was 1.4 (range, 1-3 sessions), with the average injection amount of 6.9 mL of Onyx (range, 2-25.2 mL). Sixteen AVMs (94.1%) were angiographically cured by embolization. Clinical complications occurred in 2 patients (11.7%); 1 of these was permanent (5.9%). No deaths were registered.


CONCLUSIONS
This preliminary series shows that the DACT presents satisfactory results when used with curative intent.
Division of Interventional Neuroradiology, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. dgabud@fmrp.usp.br
D G
DG
Abud
R
R
Riva
G S
GS
Nakiri
F
F
Padovani
M
M
Khawaldeh
C
C
Mounayer
D000293:Adolescent; D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D002536:Cerebral Arteries / Q000187:drug effects; D002648:Child; D003131:Combined Modality Therapy; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage*; D055815:Young Adult
D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide