Udi Sadeh-Gonike1, Nicolas Magand1,2, Xavier Armoiry3,4, Roberto Riva1, Paul Emile Labeyrie1,2, Bernadette Lamy5, Anne-Claire Lukaszewicz5,6, Jean-Jacques Lehot5, Francis Turjman1,2, Benjamin Gory1,2. 1. FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France. 2. Université Claude Bern-ard Lyon 1, Lyon, France. 3. Cellule Inno-vation/UMR-CNRS 5510/MATEIS, Bron, France. 4. Division of Health Sciences, War-wick Medical School, University of Warw-ick, Coventry, England. 5. Fédération Hosp-italo-Universitaire d'Anesthésie Réanim-ation Neurologique, Hôpital Neurolog-ique Pierre Wertheimer, Bron, France. 6. EA PI3 Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Lyon, France.
Abstract
BACKGROUND: Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined. OBJECTIVE: To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF. METHODS: We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE. RESULTS: In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I2, 0%), 3% (95% CI: 1%, 5%; I2, 0%), and 0%, respectively. CONCLUSION: This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.
BACKGROUND: Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined. OBJECTIVE: To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF. METHODS: We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE. RESULTS: In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I2, 0%), 3% (95% CI: 1%, 5%; I2, 0%), and 0%, respectively. CONCLUSION: This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.
Authors: Yosuke Akamatsu; Santiago Gomez-Paz; Daniel A Tonetti; David Vergara-Garcia; Viraj M Moholkar; Anna Luisa Kuhn; Kohei Chida; Jasmeet Singh; Katyucia de Macedo Rodrigues; Francesco Massari; Justin M Moore; Christopher S Ogilvy; Ajit S Puri; Ajith J Thomas Journal: J Cerebrovasc Endovasc Neurosurg Date: 2022-07-07
Authors: D F Vollherbst; C Herweh; S Schönenberger; F Seker; S Nagel; P A Ringleb; M Bendszus; M A Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2019-11-21 Impact factor: 3.825
Authors: Massimo Venturini; Carolina Lanza; Paolo Marra; Anna Colarieti; Marta Panzeri; Luigi Augello; Simone Gusmini; Marco Salvioni; Francesco De Cobelli; Alessandro Del Maschio Journal: CVIR Endovasc Date: 2019-02-04