Combination Of Onyx Research Articles

Efficiency of endovascular management with a combination of Onyx and coils for direct and indirect carotid cavernous fistula treatment: Experience of a single center

BackgroundTo evaluate the safety and efficacy of endovascular treatment with a combination of Onyx and coils for carotid cavernous fistulas (CCFs), and to characterize the factors associated with clinical and angiographic outcomes for direct and indirect CCFs. MethodsThis retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022. ResultsDirect and indirect CCFs were found in 14 (45.2%) and 17 (54.8%) cases, respectively. Direct CCFs included eleven traumatic carotid cavernous fistulas. The most common symptom on admission was chemosis, which was seen in 17 (54.8%) patients. Eight (25.7%) cases were treated by the transarterial approach. Fourteen (45.2%) cases were treated using the femoral vein-inferior petrosal sinus approach. Seven (22.6%) were treated by direct puncture of the superior ophthalmic vein. Two (6.5%) were treated by the femoral vein-facial vein approach. Immediate complete occlusion and follow-up rates were 93.5% and 96.7%, respectively. Twenty-nine (96.7%) patients experienced an improvement in their symptoms at clinical follow-up. Chemosis was significantly improved or resolved in 15 patients. Ophthalmoplegia was improved or resolved in 10 patients. Visual impairment was improved in 6 patients. Proptosis was improved or resolved in 5 patients. One case (3.2%) experienced procedure-related complication presented with transient oculomotor nerve palsy. In univariate subgroup analysis, use of balloon, treatment approach, and history of head trauma were significantly different between the direct and indirect CCF groups. ConclusionsEndovascular treatment with a combination of Onyx and coils is a safe and effective therapy for CCFs. In this study, the transarterial approach was a favorable option for embolization of direct CCFs. In contrast, the transvenous approach may be the first choice of treatment for indirect CCFs.

Long-Term Outcomes Following Transarterial Embolisation of Proximal Type I Endoleaks Post-EVAR.

To describe the long-term outcomes following transarterial embolisation for type Ia endoleaks (ELIa) in patients who failed or were unsuitable for standard endovascular/surgical options. A retrospective single-centre observational study was performed between October 2010 and April 2018. Technical success rates and long-term outcomes were evaluated. A sub-analysis was performed comparing outcomes of covered aortic endografts and Nellix endovascular aneurysm sealing systems. A total of 34 transcatheter embolisations were performed for ELIa in 27 patients (13 endografts and 14 patients with Nellix systems). A combination of Onyx and coils was used most frequently (18/34), followed by Onyx alone (14/34) and coils alone (2/34). Technical success was achieved in 33/34 (97%) procedures . Seven early complications occurred with no immediate mortality, 5 of which involved migration/reflux of embolic into the endograft-all successfully managed via endovascular approach. Following the surveillance period (mean 25months), 13/26 (50%) of patients were free from recurrent endoleak. Sac expansion occurred in 42% (11/26). 21/26 patients died; 6 due to aneurysm sac rupture, 10 due to unrelated causes, and 5 had no cause of death available. No significant difference in survival was found between patients with an endograft or Nellix graft-Chi-squared value - 0.011 (p < 0.05 = 3.84). Transcatheter embolisation for type Ia endoleaks is a safe and effective option in a select patient cohort-where traditional endovascular and surgical options are unsuitable or have failed. The procedure may prevent recurrence in some whilst delaying rupture and death in others.

Carotid and vertebral artery sacrifice with a combination of Onyx and coils: technical note and case series

Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combination of Onyx and coils and to assess its feasibility, safety, and efficacy. The technique consists of deploying a few coils in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. A total of 41 patients underwent carotid/vertebral artery sacrifice using this technique in our institution. A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial sacrifice. The mean number of coils used was 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). No patient developed a recurrence during the follow-up period (mean, 14 months). Parent vessel sacrifice with a combination of Onyx and coils appears to be feasible, safe, and effective and may be an alternative to the traditional deconstruction technique with coils alone. The risk of thromboembolism exists with this technique, but there were no instances of Onyx migration.

Abstract WMP26: Endovascular Arterial Deconstruction with a Combination of Onyx and Coils: Technique, Feasibility, and Complications

Object: Permanent vessel deconstruction has become routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. We describe a new technique for carotid and vertebral artery deconstruction using a combination of Onyx and coils, and assess its feasibility, safety, and efficacy. Methods: Between 2008 and 2012, a total of 41 patients underwent carotid or vertebral artery deconstruction with a combination of Onyx and coils in our institution. A few coils were initially deployed in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. Results: A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial occlusion. The mean number of coils used was only 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). All were the result of delayed ischemic events after vessel deconstruction; none were related to the occlusion technique. No patient developed a recurrence during the follow-up period (mean, 14 months). Conclusions: Parent vessel occlusion with a combination of Onyx and coils is feasible, safe, and effective and results in significant savings in terms of cost, operative time, and fluoroscopy time. Importantly, no complications related to the technique itself were encountered in the series. This new technique should replace the traditional deconstruction technique with coils alone.

Intracerebral hemorrhage following endovascular embolization of brain arteriovenous malformation with a combination of Onyx and n-butyl cyanoacrylate: a case report

We report a 29-year-old female patient who developed intracerebral hemorrhage 16 h after endovascular embolization of a brain arteriovenous malformation with a combination of liquid embolic agents of Onyx and n-butyl cyanoacrylate. After emergent craniectomy with evacuation of the hematoma, the patient recovered consciousness with mild expressive aphasia. The possible etiology of postembolization brain hemorrhage was discussed, and the literature was reviewed.

Transorbital Endovascular Embolization of Dural Carotid-Cavernous Fistula: Access to Cavernous Sinus through Direct Puncture: Case Examples and Technical Report

We present 2 cases of carotid-cavernous fistulas that failed multiple attempts at transarterial and transvenous embolization. Direct transorbital puncture for embolization was successful in curing the fistulas. The relevant anatomy and technique are reviewed. The first case is a 39-year-old man who presented with a 2-month history of worsening right-sided chemosis, proptosis, double vision, and progressive right eye vision loss. The second case is a 79-year-old woman with a 5-month history of right-sided chemosis and a 1-month history of complete left ophthalmoplegia. Cerebral angiography revealed an indirect carotid-cavernous fistula (CCF) in both patients, supplied by meningeal branches of the internal and/or external carotid arteries. After multiple unsuccessful attempts at transarterial and transvenous embolization, the CCFs were accessed via direct percutaneous transorbital puncture of the inferior and superior ophthalmic veins, respectively. The fistulas were then successfully occluded with a combination of Onyx and detachable coils. In rare cases in which more conventional transvenous and transarterial routes to a CCF have been exhausted, direct percutaneous transorbital puncture represents a viable means of achieving catheterization of the fistulous connection. In most cases, where a prominent arterialized superior ophthalmic vein is present, direct puncture represents a reasonable alternative to ophthalmologic cut-down procedures. Transorbital puncture of the inferior ophthalmic vein provides a direct route to the cavernous sinus in cases where the superior ophthalmic vein is atretic and inaccessible by direct surgical cut-down procedures.

Transarterial embolization with ONYX for treatment of intracranial non-cavernous dural arteriovenous fistula with or without cortical venous reflux

Background and purposeTo report our experience with transarterial ONYX embolization of intracranial non-cavernous dural arteriovenous fistulas (DAVFs) with or without cortical venous reflux.Materials and methodsRetrospective analysis of transarterial ONYX embolization...

Endovascular Treatment of Atypical Posterior Circulation Aneurysms: Technical Results and Review of the Literature

we report our technical success and complication rates in treating posterior circulation aneurysms at sites other than the basilar apex, superior cerebellar artery origin, or the posterior inferior cerebellar artery origin via endovascular embolization or sacrifice. we retrospectively reviewed case records for patients undergoing coil embolization of atypical posterior circulation aneurysms from January 2003 to December 2007. thirty-two aneurysms in 32 patients were treated. Twenty-one patients (65%) presented with a subarachnoid hemorrhage. Twenty-two aneurysms were treated with coiling alone, 9 with stent-assisted coiling, and 1 with a combination of Onyx plus stent-assisted coiling. Twelve aneurysms were treated with vessel sacrifice. Immediately post procedure, 27/32 aneurysms (84%) were considered successfully treated, resulting in either vessel sacrifice, complete obliteration, or minimal neck remnant. Sixteen of 19 patients (84%) were considered successfully treated at a mean angiographic follow up of 8 months. The procedural morbidity and mortality was 15% and 6% respectively. endovascular embolization remains a viable and durable method of treatment for atypical posterior circulation aneurysms.

Desaturation during Onyx embolization for intracranial arteriovenous malformations

Desaturation during Onyx embolization for intracranial arteriovenous malformations

Onyx embolization for the endovascular treatment of aneurysms associated with cerebral arteriovenous malformations:two cases report and review of the literature

Objective To study the value of onyx for the treatment of feeding artery pedicle aneurysms associated with cerebral arteriovenous malformations (AVMs).Methods Combined with review of the literatures,the clinical data of two patients suffered from large feeding artery pedicle aneurysms associated with AVMs of the distal posterior cerebral artery were analysed.Results One patient was treated with combination of onyx and coil,the other patient was simply treated with onyx according to angioarchitecture and clinical feature.The results pointed out that method combining Onyx and coil could reduce the ruptured danger of aneurysms in operation,in addition could reach completed embolization.Conclusions The method combining Onyx and coil was benefit for large feeding artery pedicle aneurysms associated with AVMs. Key words: Intracranial aneurysm; Intracranial arteriovenous malformations; Onyx; Embolization

Evaluation of a Liquid Embolization Agent (Onyx) for Transcatheter Embolization for Renal Vascular Lesions

To evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. The overall technical and clinical success rate was 100 %. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils.

Onyx Migration in the Endovascular Management of Intracranial Dural Arteriovenous Fistulas

Onyx migration in the endovascular treatment of dural arteriovenous fistulas (dural AVFs) is uncommon. We describe five cases of Onyx migration to the heart and draining vein and its avoidance. Between February 2007 and August 2008, Onyx migration was encountered in five patients with dural AVFs treated endovascularly at our institute. Procedures performed under general anesthesia consisted of two arterial approaches and three venous approaches. Two patients with dural AVFs involving the transverse-sigmoid sinus were treated by transarterial embolization using Onyx-18 via the occipital artery and the posterior branch of the middle meningeal artery, respectively. A piece of Onyx was found in the right ventricle on post-embolization chest X-ray film in both patients, one developed tricuspid valve dysfunction requiring thoracic surgery and one was asymptomatic. The other three patients were treated with a combination of Onyx (34 or 18) and coils transvenously with venous Onyx migration leading to draining vein occlusion, one with dural AVF involving the tentorium died from venous rupture, two patients with bilateral dural AVFs of the cavernous sinus (one with deterioration of ocular symptoms and one without symptoms). Postoperative digital subtraction angiography confirmed the elimination of dural AVF in one patient, and residual fistulae in three patients. The follow-up study ranging from two to nine months (average, 4.5 months). Three patients recovered to their full activities, while one had visual disturbance. Although Onyx has been considered a controllable embolic agent, its migration to other locations causing clinical deterioration can occur. This problem should be noted and prevented.

Transvenous Embolization with Onyx for Cavernous Sinus Dural Arteriovenous Fistula

Previous treatments for cavernous dural arteriovenous fistulas (DAVF) include transarterial embolization with NBCA and transvenous embolization with platinum coils. This paper presents two cases of cavernous sinus dural arterial venous fistula successfully treated via a transvenous approach with Onyx. Case 1. A 54-year-old man presented with blepharotosis, diplopia and chemosis. Cerebral angiography demonstrated a cavernous DAVF, which was successfully treated via inferior petrosal sinus with a combination of Onyx and platinum coils. Case 2. A 36-year-old woman was admitted after incomplete transarterial embolization of a dural cavernous fistula. The patien's symptoms resolved almost completely after embolization with Onyx-34 via the superior ophthalmic vein. To our knowledge, only two such cases have been reported in the literature. The advantages of Onyx make it an attractive alternative to the various platinum coils already described.