Onyx embolization of arteriovenous malformations using 2 microcatheters

Area of Science:

• Interventional Neuroradiology
• Vascular Surgery
• Neurology

Background:

• Cerebral arteriovenous malformations (AVMs) pose significant risks, necessitating effective treatment strategies.
• Embolization is a key therapeutic modality for AVMs, aiming to reduce blood flow and prevent rupture.
• Conventional embolization techniques can face challenges with reflux and procedural interruptions.

Purpose of the Study:

• To describe and evaluate a novel operative technique for cerebral AVM embolization.
• The technique utilizes two microcatheters placed in distinct arterial pedicles for Onyx embolization.
• To assess the safety and efficacy of this dual-microcatheter approach.

Main Methods:

• The technique involves placing two microcatheters into separate arterial pedicles supplying the AVM.
• Embolic agent (Onyx) is then injected alternately between the two microcatheters.
• This controlled, alternating injection aims for complete AVM occlusion.

Main Results:

• The two-microcatheter technique was performed safely in two illustrative cases.
• This approach facilitated fewer interruptions during Onyx injection.
• Improved control over Onyx reflux within the arterial pedicles was observed.

Conclusions:

• The dual-microcatheter technique offers a safe alternative for Onyx embolization of cerebral AVMs.
• It provides enhanced procedural control and reduced injection interruptions compared to conventional methods.
• This technique represents a valuable addition to the interventional neuroradiologist's armamentarium for AVM treatment.