Embolization of spinal cord arteriovenous malformations with an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx liquid embolic system)

2000 ◽  
Vol 93 (2) ◽  
pp. 304-308 ◽  
Author(s):  
Andrew J. Molyneux ◽  
Stuart C. Coley
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Promising Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Brain Avms

✓ In this paper the authors describe the first use of a new liquid embolic agent (Onyx) to treat spinal cord arteriovenous malformations (AVMs). Because its properties make it more predictable to use than currently available liquid agents, the authors believe that this material has great potential in the endovascular management of both spinal cord and brain AVMs. This very promising agent merits further clinical study.

A mixture of ethylene vinyl alcohol copolymer and ethanol yielding a nonadhesive liquid embolic agent to treat cerebral arteriovenous malformations: initial clinical experience

2002 ◽  
Vol 97 (4) ◽  
pp. 881-888 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Kiyoshi Kazekawa ◽  
Yasuji Ishimaru ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Ethanol Mixture ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Fine Print

Object. The authors report their clinical experience with their new nonadhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/ethanol mixture, to treat arteriovenous malformations (AVMs). Methods. Between June 1995 and April 2001, 57 patients with confirmed AVMs underwent embolization of their lesions with the EVAL/ethanol mixture. In 87 procedures consisting of one to three stages, the authors embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter to the vessel wall. Among the 87 embolizations undertaken in 57 patients, seven procedures (8%) in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days after four of the seven procedures; permanent neurological deficits remained after the other three procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, and 54 underwent radical treatment with microsurgical extirpation. Histopathological examination of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained 3 years after radiosurgery was administered showed that in all three patients treated in this fashion the nidus had completely disappeared. Conclusions. The EVAL/ethanol mixture is handled easily and appears to be an effective and safe agent for preoperative embolization of AVMs.

Embolization of arteriovenous malformations with peripheral aneurysms using ethylene vinyl alcohol copolymer

1991 ◽  
Vol 75 (4) ◽  
pp. 655-660 ◽  
Author(s):  
Tomoaki Terada ◽  
Yoshinari Nakamura ◽  
Kunio Nakai ◽  
Mitsuharu Tsuura ◽  
Takashi Nishiguchi ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Feeding Artery ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Liquid Embolic ◽  
Mapping Techniques

✓ The authors report three cases of arteriovenous malformations (AVM's) with aneurysms arising from the feeding artery; all were successfully treated with a new nonadhesive liquid embolic material, ethylene vinyl alcohol copolymer (EVAL). In two patients the AVM's were totally removed without difficulty, and in one the AVM was managed conservatively after embolization. No new neurological deficits appeared during or after embolization. After road-mapping techniques, EVAL was injected slowly until the feeding artery and aneurysm were completely obliterated. This embolic agent is easy to handle and is considered safe compared with other adhesive liquid embolic agents, such as isobutyl-2-cyanoacrylate or n-butyl cyanoacrylate. It is concluded that EVAL is an excellent agent for embolizing an AVM with a peripheral aneurysm on the feeding artery.

scholarly journals A Nonadhesive Liquid Embolic Agent of Ethylene Vinyl Alcohol Copolymer and Ethanol Mixture for Cerebral Arteriovenous Malformations

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 135-142 ◽  
Author(s):  
JI Hamada ◽  
Y. Kai ◽  
T. Mizuno ◽  
M. Morioka ◽  
K. Kazekawa ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Preoperative Embolization ◽  
Ethanol Mixture ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Liquid Embolic ◽  
Liquid Embolic Agent

We report our experience using our new nonadhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/Ethanol mixture, to treat human arteriovenous malformations (AVM). Between June 1995 and April 2001, 57 patients with confirmed AVM underwent embolization with the EVAL/Ethanol mixture. Using 87 procedures consisting of one to three stages, we embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter in the vessel wall. Among 87 procedures undertaken in 57 patients, seven (8.0%) procedures in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days following four of the seven procedures; permanent neurological deficits remained after three embolization procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, 54 were radically treated with microsurgical extirpation. Histopathological examinations of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained three years after they underwent radiosurgery showed that in all three patients the nidus had completely disappeared. The EVAL/Ethanol mixture is handled easily and appears to be an effective and safe embolic agent for the preoperative embolization of AVM.

scholarly journals Spinal epidural arteriovenous fistula embolization with ethylene vinyl alcohol (EVOH) copolymer using the Scepter Mini dual-lumen balloon

2020 ◽  
pp. neurintsurg-2020-016395
Author(s):  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Arnaud Pouvelle ◽  
Kevin Premat ◽  
Stéphanie Lenck ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Cord Compression ◽  
Embolic Agent ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Arteriovenous Fistulas ◽  
Low Profile ◽  
Liquid Embolic Agent ◽  
Av Fistulas ◽  
Spinal Epidural

Left unattended, spinal epidural arteriovenous fistulas (EAVFs) have a potentially severe clinical course. Embolization using ethylene vinyl alcohol (EVOH) copolymers through regular dual-lumen balloons has emerged as a potential option for the treatment of spinal arteriovenous (AV) fistulas;1–3 the main issue with this technique is the navigability of these balloons. The Scepter Mini is a low-profile, dual-lumen balloon, which may be helpful for EVOH embolization of spinal AV fistulas, as it may help to overcome the navigation drawbacks. In this technical video, we present a case of EVOH embolization of a right T6 spinal EAVF through a Scepter Mini balloon. Of note, particular attention should be paid to radiculomedullary arteries arising at the same level or at adjacent levels to avoid severe neurologic complications related to uncontrolled migration of the liquid embolic agent. Moreover, excessive use of embolic material should be avoided to prevent spinal cord compression (video 1).Video 1

Embolization of Arteriovenous Malformations with Onyx: Clinicopathological Experience in 23 Patients

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 984-997 ◽  
Author(s):  
Reza Jahan ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Harry V. Vinters ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Ease Of Use ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Martin Grade ◽  
Permanent Morbidity ◽  
Arterial Feeder ◽  
Inflammatory Changes

Abstract OBJECTIVE To report our experience in treatment of arteriovenous malformations (AVMs) using a new liquid embolic agent, Onyx (Micro Therapeutics, Inc., Irvine, CA). METHODS Between January 1998 and May 1999, 23 patients (8 men and 15 women) were treated. The patients' average age was 40 years, with seizure being the most common presenting symptom (39%). The average Spetzler-Martin grade on presentation was 3. The average AVM volume before embolization was 14.5 cm3. RESULTS We observed an average 63% reduction in AVM volume after 129 arterial feeders were embolized. There were four adverse events. Two patients experienced ischemia because of inadvertent occlusion of an arterial feeder. One of these patients made a full recovery, but the other patient had a permanent deficit. Two other patients experienced transient neurological deficits that resolved within 1 week of embolization. Permanent morbidity was thus 4% (1 of 23 patients). There were no deaths. Twelve patients underwent subsequent radiosurgery, and 11 patients had surgery that resulted in complete resection of their AVMs. Histopathological examinations showed mild acute inflammation in specimens resected 1 day after embolization. Chronic inflammatory changes were observed in specimens resected more than 4 days after embolization. In two patients, angionecrosis of the embolized vessels was noted. No evidence of parenchymal hemorrhage was observed in these patients, and vessel wall integrity was maintained as well. CONCLUSION Onyx is a new nonadhesive liquid embolic agent that has been used to treat 23 patients at our institution with good results. Its nonadhesive nature and ease of use make it a promising agent in the future treatment of AVMs.

scholarly journals Onyx injection by direct puncture for presurgical embolization of a C2 hypervascular metastasis from a thyroid cancer

2021 ◽  
pp. neurintsurg-2020-017180
Author(s):  
Frédéric Clarençon ◽  
Pierre-Emmanuel Moreau ◽  
Jonathan Cortese ◽  
Gauthier Eloy ◽  
Frédéric Deschamps ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Neurological Complications ◽  
Embolic Agent ◽  
Direct Puncture ◽  
Content Type ◽  
Massive Blood Loss ◽  
Spinal Lesion ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Video Player

Surgery for spinal hypervascular lesions, such as hemangioma or metastases from thyroid or renal cancer, may be challenging because of the risk of massive blood loss.1 To overcome this limitation, presurgical embolization has gained acceptance to reduce this risk.2 However, some configurations, such as the origin of a radiculomedullary artery close to the vessels feeding the lesion or when the lesion is supplied by vessels feeding an eloquent territory, may limit the possibility of presurgical embolization, especially with microparticles.3 Direct percutaneous puncture of the spinal lesion and subsequent embolization with liquid embolic agent may be a valuable option in such challenging cases.4We present a case of presurgical embolization of a C2 metastasis from a thyroid cancer using Onyx-18 injected by direct puncture (video 1). In this technical video, we stress the technical aspects of the direct puncture technique and the safety rules to avoid neurological complications.Video 1

A nonadhesive liquid embolic agent composed of ethylene vinyl alcohol copolymer and ethanol mixture for the treatment of cerebral arteriovenous malformations: experimental study

2002 ◽  
Vol 97 (4) ◽  
pp. 889-895 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Kiyoshi Kazekawa ◽  
Yasuji Ishimaru ◽  
...  
Keyword(s):  
Renal Artery ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Ethanol Mixture ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Delivery Technique ◽  
Fine Print

Object. The authors have developed a mixture of ethylene vinyl alcohol copolymer (EVAL) and iopamidol, which is dissolved in ethanol, as an alternative solvent to provide a safe means of embolizing arteriovenous malformations (AVMs). Methods. A two-stage delivery technique is required to prevent premature precipitation in the catheter when using this material: the catheter is first infused with 30% ethanol and this is followed by the delivery of the EVAL—ethanol mixture. Acute angiographic changes were analyzed after superselective delivery of dimethyl sulfoxide (DMSO) and 30% ethanol into the renal artery of rabbits. Histological changes following the embolization of the renal artery achieved using the EVAL—ethanol mixture were recorded at 1 hour and at 2 and 16 weeks after the procedure. Although DMSO always produced severe, rapidly progressive vasospasm in the renal artery during a 1- to 60-minute postinfusion, 30% ethanol did not. Microscopically, the lumens of embolized vessels examined 1 hour after embolization with EVAL—ethanol appeared to be filled with EVAL sponges, leaving almost no open spaces. The space between the EVAL sponges and the inner surface of the vessels was filled with fresh thrombus. In the vessel walls of specimens examined 2 weeks after embolization there was no or a slight inflammatory reaction. Scattered in the EVAL sponges were almost equal numbers of neutrophilic granulocytes and mononuclear cells, indicative of a mild inflammatory response. In specimens examined 16 weeks postembolization, the changes noted at 2 weeks were intensified. There was no definite histopathological evidence of mural hemorrhage, perivascular extravasation of the mixture, or perivascular hemorrhage in any specimen that was examined. Conclusions. Although the degree of permanence of this embolization material is yet unknown, the mixture was easy to handle, and appeared safe and effective for AVM embolization. Its nonadhesive characteristic and its ability to be infused by repeated injections make it an attractive alternative to currently available materials. The good results obtained in this study led us to undertake a clinical trial, the results of which are contained in a companion article in this issue of the Journal of Neurosurgery.

scholarly journals Onyx embolization with the Apollo detachable tip microcatheter: A single-center experience

2018 ◽  
Vol 24 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Timothy R Miller ◽  
Luciano Giacon ◽  
Matthew J Kole ◽  
Rong Chen ◽  
Gaurav Jindal ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Single Center Experience ◽  
Vessel Injury ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Technical Complication ◽  
Neurointerventional Procedures ◽  
Head Neck

Purpose The Apollo Onyx Delivery Microcatheter (Ev3, Irvine, CA) is a detachable-tip microcatheter that was developed to reduce the risk of microcatheter entrapment during ethylene-vinyl alcohol copolymer (Onyx) embolizations. We report our experience with the microcatheter in a variety of neurointerventional procedures. Methods We retrospectively reviewed all Onyx embolizations performed in the head, neck, and spine using the Apollo Onyx Delivery Microcatheter from its introduction at our institution in July 2014 to August 2016. Information regarding patient diagnoses, procedural details, as well as clinical outcomes were obtained from the electronic medical record, procedure reports, and relevant angiographic imaging. Results A total of 58 arterial pedicle Onyx embolizations were performed in 37 patients. There were no cases of microcatheter entrapment, early/inadvertent tip detachment, or vessel injury upon removal of the device. There were two instances (3.5%) of leakage of Onyx from the microcatheter detachment site during embolization, which did not result in adverse sequelae. Clinical outcomes were excellent, with nearly all embolizations achieving the intended goal. In multivariate analysis, length of Onyx reflux along the microcatheter tip and utilization of a higher viscosity agent, Onyx 34, were significantly associated with tip detachment. Conclusion The use of the Apollo Microcatheter is both safe and effective during neurointerventional embolizations using Onyx. Leakage of liquid embolic agent from the detachment site is an infrequent technical complication that may be encountered with the device.

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