A method for complete angiographic obliteration of a brain arteriovenous malformation in a single session through a single pedicle.
Historically, the endovascular treatment of arteriovenous malformations (AVM) has largely been relegated to an adjunctive role to open surgical and radiosurgical methods. In this article, we describe a novel endovascular approach to the treatment of brain AVM using Onyx (ev3 Endovascular, Plymouth, MN, USA), which may allow for a complete angiographic obliteration in a single treatment session. Twelve patients underwent Onyx embolization of an AVM using a novel "reverse plug and push" technique in which a plug is formed around the treatment catheter prior to injecting Onyx into the AVM. The plug mitigates the risk of backflow and catheter entrapment, thereby allowing the user to inject higher volumes of Onyx at higher injection rates. Patient demographics, AVM characteristics, and treatment details were reviewed. Using the "reverse plug then push" technique, an average of 8.8 mL of Onyx was injected into the AVM in a single session. In every case, the microcatheter was removed easily with minimal traction pressure. Complete angiographic obliteration was achieved in 83% of patients after a single treatment. Morbidity and mortality were 8% each. The "reverse plug then push" technique allows for a more rapid injection of Onyx due to the formation of a well-controlled plug prior to treatment, mitigating the risk of catheter entrapment by Onyx reflux. With further refinement, this technique may present a viable curative option for treatment of select brain AVM.
['Durst|Christopher R|CR|', 'Starke|Robert M|RM|', 'Gaughen|John|J|', 'Evans|Avery J|AJ|']
D000328:Adult D000368:Aged D002404:Catheterization D002533:Cerebral Angiography D004621:Embolization, Therapeutic D005260:Female D006801:Humans D002538:Intracranial Arteriovenous Malformations D008297:Male D008875:Middle Aged D011183:Postoperative Complications D012189:Retrospective Studies D013345:Subarachnoid Hemorrhage D016896:Treatment Outcome
Brain Arteriovenous malformation Onyx Embolization