title: Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study.
abstract: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid embolic agent, in the treatment of patients with cranial dural arteriovenous fistulas. The primary end point was the rate of complete occlusion of dural arteriovenous fistulas. Secondary end points included the incidence of adverse events and clinical status at 3-month follow-up.
  
  
  
  This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started in August 2014 and ended in September 2015.
  
  
  
  Twenty-two (85%) patients were treated with PHIL only, with 3 patients treated with both PHIL and Onyx, and 1, with both PHIL and coils. Immediate complete angiographic occlusion was achieved in 20 (77%) patients. Of the 6 patients with residual fistulas, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein.
  
  
  
  PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.
authors.affiliation: From the Department of Neuroradiology (S.L., H.S.C., S.C., A.T.), University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, UK Saleh.Lamin@uhb.nhs.uk.
authors.forename: S
authors.identifier: 0000-0002-2208-7501
authors.initials: S
authors.lastname: Lamin
authors.affiliation: From the Department of Neuroradiology (S.L., H.S.C., S.C., A.T.), University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
authors.forename: H S
authors.identifier: 0000-0002-1802-3935
authors.initials: HS
authors.lastname: Chew
authors.affiliation: From the Department of Neuroradiology (S.L., H.S.C., S.C., A.T.), University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
authors.forename: S
authors.identifier: 0000-0002-7488-0675
authors.initials: S
authors.lastname: Chavda
authors.affiliation: From the Department of Neuroradiology (S.L., H.S.C., S.C., A.T.), University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, UK.
authors.forename: A
authors.identifier: 0000-0002-3202-1071
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Neuroradiologia Department (M.P., L.Q., G.P.), Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: M
authors.identifier: 0000-0003-0470-1202
authors.initials: M
authors.lastname: Piano
authors.affiliation: Neuroradiologia Department (M.P., L.Q., G.P.), Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: L
authors.identifier: 0000-0002-0798-6197
authors.initials: L
authors.lastname: Quilici
authors.affiliation: Neuroradiologia Department (M.P., L.Q., G.P.), Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: G
authors.identifier: 0000-0002-8932-6909
authors.initials: G
authors.lastname: Pero
authors.affiliation: Department of Neuroradiology, Section 3023 (M.H., M.E.C.), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M
authors.identifier: 0000-0003-2536-5244
authors.initials: M
authors.lastname: Holtmannspolter
authors.affiliation: Department of Neuroradiology, Section 3023 (M.H., M.E.C.), University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M E
authors.identifier: 0000-0002-1857-0525
authors.initials: ME
authors.lastname: Cronqvist
authors.affiliation: Instituto de Neurociencias Avanzadas de Madrid (A.C., L.G., L.P., A.G.G., A.A.), Hospital Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: A
authors.identifier: 0000-0001-7990-2995
authors.initials: A
authors.lastname: Casasco
authors.affiliation: Instituto de Neurociencias Avanzadas de Madrid (A.C., L.G., L.P., A.G.G., A.A.), Hospital Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: L
authors.identifier: 0000-0001-5484-4813
authors.initials: L
authors.lastname: Guimaraens
authors.affiliation: Instituto de Neurociencias Avanzadas de Madrid (A.C., L.G., L.P., A.G.G., A.A.), Hospital Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: L
authors.identifier: 0000-0003-1307-1695
authors.initials: L
authors.lastname: Paul
authors.affiliation: Instituto de Neurociencias Avanzadas de Madrid (A.C., L.G., L.P., A.G.G., A.A.), Hospital Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: A
authors.identifier: 0000-0002-9376-1639
authors.initials: A
authors.lastname: Gil Garcia
authors.affiliation: Instituto de Neurociencias Avanzadas de Madrid (A.C., L.G., L.P., A.G.G., A.A.), Hospital Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: A
authors.identifier: 0000-0002-2581-5535
authors.initials: A
authors.lastname: Aleu
authors.affiliation: Klinik für Radiologie und Neuroradiologie (R.C.), Alfried Krupp Krankenhaus, Essen, Germany.
authors.forename: R
authors.identifier: 0000-0002-9245-0636
authors.initials: R
authors.lastname: Chapot
mesh_terms: D000328:Adult; D000368:Aged; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011145:Polyvinyls; D004121:Dimethyl Sulfoxide