The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations

PURPOSEWe aimed to evaluate the safety and feasibility of the embolization of peripheral arteriovenous malformation (AVM) with non-adhesive liquid agents (NALA) injected by dual-lumen balloons (DLB).METHODSWe conducted a multicenter retrospective study between January 2017 and June 2019, including patients with peripheral AVM embolized with NALA by DLB. Fourteen patients were included. The AVM classification, technical and clinical success were evaluated, as were nidus size, liquid agent used, volume and time of injection in DLB, complications, follow-up and need of surgical intervention.RESULTSThe mean age of the patients was 37±22.5 years (range, 6–82 years). The mean nidus size was 5.2±2.4 cm (range, 3.0–12.0 cm). By Schobinger classification, 11 AVMs were classified in stage 3 and 3 AVMs were classified in stage 2. By Cho’s classification, 2 AVMs were in stage II, 4 AVMs were in stage I, 4 AVMs were in stage IIIa and 4 AVMs were in stage IIIb. Onyx was used in 11 patients (78.6%), while Squid, PHIL, and both Onyx and Squid were used in one patient each (7.1%). Seven patients (50%) required one session of embolization, 4 patients (28.6%) required two, 2 patients (14.3%) required three and 1 patient (7.1%) required four sessions. Complete nidus exclusion was achieved in 11 patients (78.6%), optimal clinical response in 12 patients (85.7%). Four patients (28.6%) exhibited minor complications, all controlled. No major complications were seen. Four patients underwent surgical intervention (28.6%). CONCLUSIONThe embolization of peripheral AVM with NALA in DLB appears to be safe and feasible, achieving high rates of technical and clinical success

Evaluation of occlusion rates of intracranial aneurysms treated with a flow diverter device - the role of branches arising from the sac

Objetivo: o propósito desse estudo foi comparar os desfechos clínicos e angiográficos do tratamento de aneurismas intracranianos com e sem ramos originando-se do interior do saco aneurismático após tratamento com o Dispositivo de Embolização Pipeline (PED). Métodos: esse estudo retrospectivo envolvendo dois centros incluiu 116 pacientes portadores de 157 aneurismas tratados com o PED. Dividiram-se os aneurismas em 2 grupos: um grupo com ramos originando-se do interior do aneurisma e outro grupo sem tais ramos. Os desfechos incluíram a taxa de oclusão dos aneurismas avaliada por angiografia de controle após 6 e 12 meses do tratamento, morte, isquemia ou hemorragia cerebral, complicações técnicas, estenose no interior do PED, patência dos ramos cobertos e isquemia transitória. Resultados: cento e cinquenta e um aneurismas (96%) localizavam-se na artéria carótida interna. Observou-se um ramo originando-se do interior do saco em 26 aneurismas. Obtevese oclusão completa em 120 de 156 aneurismas após 6 meses (76,92% [95% IC 69,71%-82,84%]) e em 136 de 155 aneurismas após 12 meses (87,14% [95% IC 81,28%-92,27%]). A oclusão total foi mais frequente no grupo sem um ramo originando-se do interior do aneurisma (84% versus 40% em 6 meses, p<0.001; 93,10% versus 60% em 1 ano, p<0.001). Houve 4 (3,45% [95% IC 1,11%-9,12%]) casos de morte ou acidente vascular cerebral maior. Amaurose fugaz ocorreu em 3 pacientes. Um paciente apresentou piora do efeito de massa. Nenhuma oclusão de ramo originando-se do aneurisma ocorreu. Estenose maior do que 50% no interior do PED ocorreu em 1 caso. Conclusão: aneurismas tratados com o PED apresentam menor probabilidade de ocluírem totalmente se possuírem um ramo originando-se do interior do saco em comparação com aqueles aneurismas que não possuem esse ramo.Objective: the aim of this study was to compare the clinical and angiographic outcomes of intracranial aneurysms with and without branches arising from the sac after Pipeline Embolization Device (PED) treatment. Method: this retrospective 2- center comparative study included 116 patients with 157 aneurysms that were treated with PEDs. Aneurysms were divided into 2 groups: one group had branches arising from the sac and the other group did not. Study end points included total aneurysm occlusion assessed by angiography at 6 and 12 months, death or stroke, technical complications, in-stent stenosis, patency of covered branches, and transient ischemia. Results: one hundred fifty-one aneurysms (96%) were located in the internal carotid artery. A branch arising from the sac was observed in 26 aneurysms. Complete occlusion was found in 120 of 156 aneurysms at 6 months (76.92% [95% CI 69.71%- 82.84%]) and in 136 of 155 aneurysms at 12 months (87.74% [95% CI 81.28%- 92.27%]). Total occlusion?was more frequently observed in the group without a branch arising from the sac (84% vs 40% at 6 months, p < 0.001; 93.10% vs 60% at 1 year, p < 0.001). There were 4 (3.45% [95% CI 1.11%-9.12%]) cases of death or major stroke. Amaurosis fugax occurred in 3 patients. One patient experienced worsening of mass effect after treatment. No occlusion of branches arising from the aneurysm was observed. In-stent stenosis greater than 50% was observed in 1 case. Conclusion: aneurysms treated with PEDs are less likely to be totally occluded if they have a branch arising from the sac than are aneurysms without these branches

Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series Fístulas arteriovenosas durais com drenagem cortical direta tratadas com Onyx®: casuística

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.<br>As fistulas arteriovenosas durais (FAVDs) podem se manifestar com sintomas agressivos, especialmente se existe drenagem cortical direta. Relatamos nossa experiência preliminar na embolização transarterial de FAVDs com drenagem cortical direta usando Onyx®. MÉTODO: Nove pacientes com FAVDs com drenagem cortical direta foram tratados: oito do tipo IV e uma do tipo III (Cognard). O tratamento consistiu na embolização transarterial usando Onyx-18®. Angiografias imediatas pós-tratamento, evolução clínica e angiografias de controle tardias foram estudadas. RESULTADOS: A oclusão completa da fístula foi alcançada em todos pacientes através de um só procedimento e injeção em apenas um pedículo arterial. No seguimento, oito pacientes ficaram livres de sintomas, um melhorou e nenhum deteriorou. Angiografias tardias de controle não mostraram evidência de FAVD recorrente. CONCLUSÃO: Nós recomendamos que a embolização transarterial com Onyx® das FAVDs com drenagem cortical direta, seja considerada como uma opção terapêutica, uma vez que mostrou ser factível, segura e efetiva