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ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas
  1. James David Rabinov1,
  2. Albert J Yoo1,
  3. Christopher S Ogilvy2,
  4. Bob S Carter3,
  5. Joshua A Hirsch1
  1. 1Division of Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Neurosurgery, University of California, San Diego, California, USA
  1. Correspondence to Dr James David Rabinov, Department of Neuroradiology/Gray241, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; jrabinov{at}partners.org

Abstract

Purpose To evaluate the efficacy of n-butyl-2-cyanoacrylate (Trufill n-BCA) versus ethylene vinyl alcohol copolymer (ONYX) for the embolization of cranial dural arteriovenous fistulas (DAVF).

Methods Fifty-three consecutive patients with cranial dural AVF were treated with liquid embolic agents from November, 2003 to November, 2008. These 53 patients had 56 lesions treated with arterial embolization. Patients embolized to completion underwent follow-up angiography at 3 months to assess for durable occlusion.

Results Twenty-one lesions were treated with n-BCA. Seven patients treated with n-BCA had initial angiographic occlusion of their DAVF, which were durable at 3 months. Six patients had adjunctive treatment with coils and/or polyvinyl alcohol particles, but none of these were occluded by endovascular treatment alone. Eleven patients underwent post-embolization surgery for closure of their DAVF. There was one death related to intractable status epilepticus at presentation. One patient developed a major stroke from venous sinus thrombosis after embolization. Thirty-five lesions were treated with ONYX in 34 patients. Twenty-nine patients treated with ONYX had initial angiographic occlusion of their DAVF by embolization alone. One patient had recurrence at 3 months and was re-treated out of 27 total follow-ups. Four patients underwent post-embolization surgical obliteration of their lesions. No deaths or major strokes occurred in this cohort.

Conclusion Initial angiographic occlusion (p=0.0004) and durable angiographic occlusion (p=0.0018) rates for embolization of cranial DAVF show a statistically significant higher efficacy with ONYX compared with n-BCA. Patients embolized with ONYX underwent surgery less frequently compared with those treated with n-BCA (p=0.0015).

  • Aneurysm
  • angiography
  • angioplasty
  • arteriovenous malformation
  • artery
  • atherosclerosis
  • brain
  • coil
  • dural AVF
  • embolization
  • fistula
  • intervention
  • navigation
  • n-BCA
  • ONYX
  • political
  • spine
  • stenosis
  • stent
  • subarachnoid
  • thrombectomy

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Massachusetts General Hospital Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for our study are available to other researchers if they choose to gain access by Massachusetts General Hospital Institutional Review Board approved methods.

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