Srinivasan Paramasivam1, Yasunari Niimi, Johanna Fifi, Alejandro Berenstein. 1. 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.
Abstract
INTRODUCTION: 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 AND TECHNIQUE: 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. CONCLUSION: 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.
INTRODUCTION: 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 AND TECHNIQUE: 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. CONCLUSION: 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.
Authors: Tales V C Albuquerque; Dimitrius Nikolaos Jaconi Stamoulis; Lucas M Monsignore; Luis Henrique de Castro-Afonso; Guilherme Seizem Nakiri; Marco Tulio Rezende; Felipe Padovani Trivelato; José Ricardo Vanzin; Alexandre Cordeiro Ulhoa; Daniel G Abud Journal: Diagn Interv Radiol Date: 2021-03 Impact factor: 2.630
Authors: J O Zamponi; F P Trivelato; M T S Rezende; R K Freitas; L H de Castro-Afonso; G S Nakiri; T G Abud; A C Ulhôa; D G Abud Journal: AJNR Am J Neuroradiol Date: 2020-10-01 Impact factor: 3.825
Authors: Bradley A Gross; Daniel A Tonetti; Gregory M Weiner; David M Panczykowski; William J Ares; Cynthia L Kenmuir; Ashutosh P Jadhav; Tudor G Jovin; Brian T Jankowitz Journal: Interv Neurol Date: 2017-06-21