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  • ‘Pressure cooker’ and ‘balloon pressure’ techniques significantly increase 3-month complete occlusion rate after spinal arteriovenous fistula embolization as compared to glue: single center evaluation on 38 consecutive patients

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New devices and techniques
Original research
‘Pressure cooker’ and ‘balloon pressure’ techniques significantly increase 3-month complete occlusion rate after spinal arteriovenous fistula embolization as compared to glue: single center evaluation on 38 consecutive patients
  1. Damien Parat1,
  2. Benjamin Granger2,3,
  3. Eimad Shotar4,
  4. Kevin Premat4,
  5. Vincent Reina5,
  6. Mehdi Drir5,
  7. Gaspard Gerschenfeld6,
  8. Atika Talbi4,
  9. Stephanie Lenck4,
  10. Nader Sourour4,
  11. Frédéric Clarençon3,4,7
  1. 1 Radiologie, Assistance Publique - Hopitaux de Paris, Paris, France
  2. 2 Department of Public Health, APHP, Paris, France
  3. 3 Sorbonne University, Paris, France
  4. 4 Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
  5. 5 Department of Neurosurgery, Pitié-Salpêtrière Hospital, APHP, Paris, France
  6. 6 Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
  7. 7 GRC BioFast, Sorbonne University, Paris, France
  1. Correspondence to Dr Damien Parat; damienparat{at}gmail.com

Abstract

Background Spinal arteriovenous fistulas can be treated either by surgery or by endovascular means, using different strategies. The main drawback of embolization is the risk of recurrence. Our objective is to evaluate the angiographic occlusion rate and the predictive factors of angiographic cure of spinal arteriovenous fistulas at 3 months or more after embolization.

Methods This is a retrospective single-center study including 38 consecutive patients with spinal arteriovenous fistulas treated by embolization as first-line treatment. We reviewed clinical and imaging data, complications, and the immediate angiographic occlusion rate of the fistulas, and at 3 months or more after the embolization.

Results A total of 45 embolization procedures were performed: 30 procedures using glue, 15 using Onyx by ‘pressure cooker’ or ‘balloon pressure’ techniques. We observed no statistically significant difference between the two groups concerning the immediate angiographic occlusion rate (87% in both groups; P>0.9), as well as for periprocedural complication rates. The angiographic occlusion rate at 3 months or more was higher in the Onyx ‘combined’ techniques treated group (87% vs 40%, P=0.007). The use of Onyx ‘combined’ techniques was independently associated with angiographic cure at 3 months after embolization (P=0.029). No other factors were identified as predictive of angiographic cure and clinical recovery after embolization procedures, nor were any predictive factors identified for the occurrence of periprocedural complications.

Conclusion Embolization of spinal arteriovenous fistulas with Onyx using ‘combined’ techniques appears to be safe and associated with a higher rate of angiographic occlusion at 3 months than regular embolization with glue.

  • Fistula
  • Technique
  • Vascular Malformation
  • Liquid Embolic Material
  • Balloon

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020621

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors DP: data collection, angiogram analysis, conducted and planned the report of the work. BG: data analysis (statistician). ES: provided and cared for study patients, critically reviewed the study proposal. KP: provided and cared for study patients, critically reviewed the study proposal. VR: provided and cared for study patients. MD: provided and cared for study patients. GG: provided and cared for study patients. AT: data collection. SL: provided and cared for study patients, critically reviewed the study proposal. NS: provided and cared for study patients, critically reviewed the study proposal. FC: angiogram analysis, provided and cared for study patients, conducted and planned the report of the work. FC is the guarantor of the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Professor F Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core lab; non-related to the study). Dr Nader-Antoine Sourour is consultant for Medtronic, Balt Extrusion, Microvention, stock/stock options: Medina. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.