title: Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience.
abstract: BACKGROUND
  Conventional Onyx embolization of cerebral arteriovenous malformations (AVMs) requires lengthy procedure and fluoroscopy times to form an adequate 'proximal plug' which allows forward nidal penetration while preventing reflux and non-targeted embolization. We review our experience with balloon-augmented Onyx embolization of cerebral AVMs using a dual-lumen balloon catheter technique designed to minimize these challenges.
  
  
  METHODS
  Retrospectively acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 were obtained from four tertiary care centers. For each procedure, at least one Scepter C balloon catheter was advanced into the AVM arterial pedicle of interest and Onyx embolization was performed through the inner lumen after balloon inflation via the outer lumen.
  
  
  RESULTS
  Twenty patients underwent embolization with the balloon-augmented technique over 24 discreet treatment episodes. There were 37 total arterial pedicles embolized with the balloon-augmented technique, a mean of 1.9 per patient (range 1-5). The treated AVMs were heterogeneous in their location and size (mean 3.3±1.6 cm). Mean fluoroscopy time for each procedure was 48±26 min (28 min per embolized pedicle). Two Scepter C balloon catheter-related complications (8.3% of embolization sessions, 5.4% of pedicles embolized) were observed: an intraprocedural rupture of a feeding pedicle and fracture and retention of a catheter fragment.
  
  
  CONCLUSIONS
  This multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs. The technique appears safe and effective in the treatment of AVMs, allowing more efficient and controlled injection of Onyx with a decreased risk of reflux and decreased fluoroscopy times.
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
authors.affiliation: Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA Division of Neurosurgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: James
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lowe
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Vargas
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Aquilla S
authors.initials: AS
authors.lastname: Turk
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: M Imran
authors.initials: MI
authors.lastname: Chaudry
authors.affiliation: Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhalla
authors.affiliation: Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Janjua
authors.affiliation: Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Delaney
authors.affiliation: Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Quintero-Wolfe
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
mesh_terms: D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D005471:Fluoroscopy; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Arteriovenous Malformation