Effectiveness of ONYX liquid embolic agent in endovascular treatment of cerebral arteriovenous malformations - own experience Poster No.: C-0709 Congress: ECR 2011 Type: Scientific Exhibit Authors: K. Brzozowski, P. Ziecina, P. Piasecki, E. Frankowska, P. 1 1 1 2 1 1 2 2 Zukowski, R. Bogus#awska ; Warsaw/PL, Warszawa/PL Keywords: Cardiovascular system, Head and neck, Interventional vascular, Catheter arteriography, Embolisation, Arteriovenous malformations DOI: 10.1594/ecr2011/C-0709 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 11
Purpose Endovascular treatment of cerebral arteriovenous malformations (AVMs) is strenuous and multistage process. Each of currently available embolic materials has advantages and flaws, what makes the choice difficult. Aim of the study was to assess efficacy of AVMs endovascular treatment using ONYX embolic material. Page 2 of 11
Images for this section: Fig. 0: DSA image of AVM-related false aneurysm (arrow) after coil embolization - arterial (A) and venous phase (B). Department of Interventional Radiology, Military Institute of Health Services, Central Teaching Hospital of the Ministry of National Defence, Warsaw, Poland 2011 Fig. 0: DSA. AVM in the left frontotemporal region after embolization of pseudoaneurysm. Microcatheter injection of contrast media - position of microcatheter tip before embolization with liquid embolic agent Onyx (A). Postembilization images - arterial (B) and venous phase (C). Department of Interventional Radiology, Military Institute of Health Services, Central Teaching Hospital of the Ministry of National Defence, Warsaw, Poland 2011 Page 3 of 11
Methods and Materials A total of 30 procedures were performed in 22 patients (11 women, 11 men) in our center between December 2008 and January 2010. The mean age was 41 + 23 years. The Spetzler-Martin grading scale values were as follows: one patient was Grade I, 2 patients were Grade II, 8 patients were Grade III, 4 patients were Grade IV and 7 patients were Grade V. We used ONYX 18, 20 i 34 as embolic material. Efficacy of embolization was assessed after every stage of the procedure. Page 4 of 11
Images for this section: Fig. 0: AVM in the left temporal region before (A) and after embolization with Onyx (B) with 80% reduction of AVM volume. Deposits of embolization material (arrow) (C). Department of Interventional Radiology, Military Institute of Health Services, Central Teaching Hospital of the Ministry of National Defence, Warsaw, Poland 2011 Page 5 of 11
Results After single session of ONYX embolization the mean reduction of AVM volume was 42,5% (20-99%). After multiple session ONYX embolization (> 2 procedures) we achieved 20 to 80% reduction of the AVM volume. Follow-up angiography showed stable and lasting deposition of embolic material. In 4 patients (13,3%) undesired embolic material leakage past the AVM venous outflow occurred, without clinical deficits. Page 6 of 11
Images for this section: Fig. 0: Complication of AVM embolization with Onyx 34. Dislocation of embolization material into sinus rectus (arrow) (A, B). Venous outflow was preserved (C, D). Department of Interventional Radiology, Military Institute of Health Services, Central Teaching Hospital of the Ministry of National Defence, Warsaw, Poland 2011 Page 7 of 11
Conclusion In our experience, usage of ONYX agent for AVM embolization provides greater reduction of the malformation volume compared to other embolic materials, such as mixture of histoacryl and lipiodol. We also observed stable and lasting deposition of embolic material in AVM nidus and venous outflow in follow-up examinations. The procedure is associated with low complication rate. Page 8 of 11
Images for this section: Fig. 0: Complication of AVM embolization with Onyx. Dislocation of embolization material into transverse and sigmoid sinuses, internal jugular sinus (arrows) (A) and subsequently to segmental pulmonary artery of the right lower lobe (arrow) (B). Department of Interventional Radiology, Military Institute of Health Services, Central Teaching Hospital of the Ministry of National Defence, Warsaw, Poland 2011 Page 9 of 11
References 1. van Rooij WJ, Sluzewski M, Beute GN. Brain AVM embolization with Onyx. Am J Neuroradiol. 2007 Jan;28(1): 172-7. 2. Weber W, Kis B, Siekmann R, Kuehne DA. Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects. Am J Neuroradiol. 2007 Feb;28(2): 371-7. 3. Mounayer C, Hammami N, Piotin M, et al. Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients. Am J Neuroradiol. 2007 Mar;28(3): 518-23. 4. Xu F, Ni W, Liao Y, et al. Onyx embolization for the treatment of brain arteriovenous malformations. Acta Neurochir (Wien). 2010 Oct 28. [Epub ahead of print]. 5. Walecki J. Post#py Neuroradiologii. Warszawa: Polska Fundacja Upowszechniania Nauki, 2007. Page 10 of 11
Personal Information Piotr Zi#cina Department of Interventional Radiology Military Institute of Health Service Szaserów 128 Str., 04-141 Warsaw e-mail: ziecinap@gmail.com Page 11 of 11