Prime esperienze di embolizzazione di MAV cerebrali con Onyx®: Analisi del trattamento di sette pazienti

Translated title of the contribution: Initial experience of cerebral AVMs embolisation with Onyx: Analysis of treatment in seven patients

L. Simonetti, P. Cenni, F. De Santis, C. Sturiale, A. Andreoli, A. Fioravanti, F. Calbucci, M. Leonardi

Research output: Contribution to journalArticle

Abstract

The endovascular approach to arteriovenous malformations (AVM) using different embolising agents is a well-established treatment option. The procedure allows complete closure of the malformation in around a quarter of all cases reported in different literature series with significant variability among different authors. The incidence of major complications also varies widely: in our opinion, this is because successful treatment is highly operator-dependent. In turn, this operator-dependency is linked to use of a valid but difficult to manage embolising agent like acrylic glue (Histoacryl). Choice of cyanoacrylate dilution, the speed and technique of glue injection in relation to microcatheter position are empirical skills difficult to transmit from one operator to another and often applied on the basis of personal experience. The outcome is that although acrylic glue is a valid embolising agent applied for many years, it remains difficult to use with significant risks for the patient. Another negative feature of the glue is the fact that because of the potential risk of serious complications, acrylic glue manufacturers have not given the product the EU trademark for endovascular use which is included among the prohibited indications. This situation has recently created difficult working conditions, especially from the legal standpoint, despite widespread application for many years (also acknowledged by the Italian Ministry of Health, which can authorise the use of glue on an individual patient basis). This situation accounts for the ongoing search for safer alternative embolising agents whose application can be standardised within limits feasible for any interventional procedure. A new embolising material, Onyx (Onyx System MicroTherapeutics, Inc., MTI), was marketed some years ago as a "foam" with the theoretical feature of progressive occlusion rather than immediate gluing. We report the results obtained in the first seven patients treated with Onyx in the last six months, analysing the application technique and our impressions during treatment in relation to our past experience with cyanoacrylate glue. In one patient we have obtained complete angiographic occlusion of the AVM. In another case we have reached an 80% occlusion and the patient has completed the treatment with surgical approach, without any problem. The other patients are still in treatment. In our experience the Onyx gives good results and it seems easier to use in comparison with the cyanoacrylate.

Original languageItalian
Pages (from-to)85-91
Number of pages7
JournalRivista di Neuroradiologia
Volume15
Issue number1
Publication statusPublished - 2002

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Adhesives
Cyanoacrylates
Arteriovenous Malformations
Therapeutics
Enbucrilate
Indicator Dilution Techniques
Patents
Injections
Incidence
Health

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Radiological and Ultrasound Technology

Cite this

Prime esperienze di embolizzazione di MAV cerebrali con Onyx® : Analisi del trattamento di sette pazienti. / Simonetti, L.; Cenni, P.; De Santis, F.; Sturiale, C.; Andreoli, A.; Fioravanti, A.; Calbucci, F.; Leonardi, M.

In: Rivista di Neuroradiologia, Vol. 15, No. 1, 2002, p. 85-91.

Research output: Contribution to journalArticle

Simonetti, L, Cenni, P, De Santis, F, Sturiale, C, Andreoli, A, Fioravanti, A, Calbucci, F & Leonardi, M 2002, 'Prime esperienze di embolizzazione di MAV cerebrali con Onyx®: Analisi del trattamento di sette pazienti', Rivista di Neuroradiologia, vol. 15, no. 1, pp. 85-91.
Simonetti, L. ; Cenni, P. ; De Santis, F. ; Sturiale, C. ; Andreoli, A. ; Fioravanti, A. ; Calbucci, F. ; Leonardi, M. / Prime esperienze di embolizzazione di MAV cerebrali con Onyx® : Analisi del trattamento di sette pazienti. In: Rivista di Neuroradiologia. 2002 ; Vol. 15, No. 1. pp. 85-91.
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