Experiences With Balloon-Augmented Onyx Embolization of Cerebral AVMs Reported

September 15, 2015—In the Journal of NeuroInterventional Surgery (JNIS), Alejandro M. Spiotta, MD, et al published findings from a multicenter experience with balloon-augmented Onyx (Medtronic plc) embolization of cerebral arteriovenous malformations (AVMs) using a dual-lumen balloon catheter technique (2015;7:721–727). The investigators explained that this approach is intended to minimize the challenges of conventional Onyx embolization of cerebral AVMs that requires lengthy procedure and fluoroscopy times to form an adequate proximal plug to allow forward nidal penetration while preventing reflux and nontargeted embolization. 

As summarized in JNIS, the investigators retrospectively obtained the acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 at four tertiary care centers. For each procedure, at least one Scepter C balloon catheter (MicroVention, Inc., a subsidiary of Terumo Corporation) 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.

According to the investigators, this multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs.

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, 3.3 ± 1.6 cm). Mean fluoroscopy time for each procedure was 48 ± 26 min (28 min 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.

The investigators concluded that 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.