Onyx embolization using dual-lumen balloon catheter: initial experience and technical note.
BACKGROUND
Onyx as an embolization agent for the management of vascular malformation is well established. We report our initial experience with dimethyl-sulphoxide (DMSO) compatible double lumen balloon catheters used for Onyx embolization.


METHODS
Between December 2011 and March 2013, we treated 22 patients aged between 1.5 to 70years with two types of DMSO compatible dual-lumen balloon catheters (Scepter C and Ascent) to treat dural arteriovenous fistulas, brain arteriovenous malformation (AVM) with dural feeders, mandibular, facial, lingual, vertebral and paravertebral AVMs. The catheter has good navigability, compliant balloon on inflation formed a "plug" that has more resistance than Onyx plug enhancing better penetration. During injection, the balloon remained stable without spontaneous deflation or rupture and withstood the pressure build-up well. The retrieval of the catheter in most cases took less than a minute (19/28) while in five, it was less than five minutes and in the remaining four, it was longer that includes a trapped catheter on prolonged attempted retrieval resulted in an epidural hematoma, requiring emergent surgical evacuation. The fluoroscopy time is reduced, as we do not form a proximal onyx plug, the injection time is shorter along with easy and instantaneous removal of the catheter after balloon deflation in most cases.


CONCLUSIONS
Dual-lumen balloon catheter Onyx embolization is a safe and effective technique. Currently, an important tool to circumvent some of the shortcomings associated with Onyx embolization. The catheter has good navigability, the balloon has stability, tolerance, enhances penetrability. It is easy to retrieve the microcatheter. With the experience gained, and with more compliant balloon catheters available, this technique can be applied to cerebral vessels in near future.
Hyman Newman Institute for Neurology and Neurosurgery, Centre for Endovascular Surgery, Roosevelt Hospital, 1000 Tenth Avenue, Suite 10 G, New York, 10019, United States. Electronic address: kpsvasan@hotmail.com.
Srinivasan
S
Paramasivam
Yasunari
Y
Niimi
Johanna
J
Fifi
Alejandro
A
Berenstein
D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011145:Polyvinyls / Q000008:administration & dosage*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
Balloon catheter; DMSO compatible catheter; Dual-lumen balloon catheter; Dural fisutlas; Facial AVM; Onyx