Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience
Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience
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DOI：
10.1136/neurintsurg-2014-011285
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发表时间：
2015-10-01
影响因子：
4.8
通讯作者：
Turner, Raymond D.
中科院分区：
文献类型：
--
作者：
Spiotta, Alejandro M.;James, Robert F.;Turner, Raymond D.
传统的脑动静脉畸形（AVMs）的Onyx栓塞需要漫长的程序和透视时间，以形成一个足够的近端塞，允许向前穿透针头，同时防止反流和非靶向栓塞。我们回顾了我们使用双腔球囊导管技术对脑动静脉畸形进行球囊增强的Onyx栓塞的经验，旨在最大限度地减少这些挑战。方法回顾性获取2011年至2014年期间在4个三级医疗中心进行的所有球囊增强脑AVM栓塞的数据。对于每个手术，至少有一个Scepter C球囊导管进入感兴趣的AVM动脉蒂，球囊通过外腔膨胀后，通过内腔进行Onyx栓塞。结果20例患者在24次谨慎治疗中采用球囊增强技术栓塞。用球囊增强技术栓塞了37个动脉蒂，平均每位患者1.9个（范围1-5）。处理后的动静脉在位置和大小上存在差异（平均3.31.6cm）。每次手术的平均透视时间为48±26分钟（每个栓塞椎弓根28分钟）。观察到2例Scepter C球囊导管相关并发症（8.3%的栓塞次数，5.4%的蒂栓塞）：术中喂养蒂破裂、骨折和导管碎片潴留。结论：该多中心经验是目前报道的最大的脑动静脉畸形球囊增强的缟玛石栓塞系列。该技术在治疗avm方面安全有效，允许更有效和控制的Onyx注射，降低反流风险和减少透视时间。
Introduction Conventional Onyx embolization of cerebral arteriovenous malformations (AVMs) requires lengthy procedure and fluoroscopy times to form an adequate proximal plug' which allows forward nidal penetration while preventing reflux and non-targeted embolization. We review our experience with balloon-augmented Onyx embolization of cerebral AVMs using a dual-lumen balloon catheter technique designed to minimize these challenges.Methods Retrospectively acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 were obtained from four tertiary care centers. For each procedure, at least one Scepter C balloon catheter was advanced into the AVM arterial pedicle of interest and Onyx embolization was performed through the inner lumen after balloon inflation via the outer lumen.Results Twenty patients underwent embolization with the balloon-augmented technique over 24 discreet treatment episodes. There were 37 total arterial pedicles embolized with the balloon-augmented technique, a mean of 1.9 per patient (range 1-5). The treated AVMs were heterogeneous in their location and size (mean 3.31.6cm). Mean fluoroscopy time for each procedure was 48 +/- 26min (28min per embolized pedicle). Two Scepter C balloon catheter-related complications (8.3% of embolization sessions, 5.4% of pedicles embolized) were observed: an intraprocedural rupture of a feeding pedicle and fracture and retention of a catheter fragment.Conclusions This multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs. The technique appears safe and effective in the treatment of AVMs, allowing more efficient and controlled injection of Onyx with a decreased risk of reflux and decreased fluoroscopy times.