Update Onyx embolization for plexiform arteriovenous malformation: Ante-grade drifting technique.

Area of Science:

• Interventional Neuroradiology
• Vascular Surgery
• Neurology

Background:

• Conventional arteriovenous malformation (AVM) embolization using Onyx injection carries risks of periprocedural bleeding complications.
• An updated ante-grade drifting Onyx injection technique was developed to potentially mitigate these risks.

Purpose of the Study:

• To evaluate the safety and efficacy of the ante-grade drifting Onyx injection technique for embolizing plexiform AVMs.
• To identify factors associated with successful AVM obliteration and complications.

Main Methods:

• A retrospective study of 101 consecutive patients with plexiform AVMs treated between January 2016 and December 2018.
• Patients' clinical status was assessed using the modified Rankin Scale (mRS).
• Logistic regression analyses were employed to determine associations with outcomes.

Main Results:

• Complete AVM obliteration was achieved in 51.2% of patients.
• Two cases (2.0%) of arterial perforation occurred without neurological deficits.
• Younger age, hemorrhagic presentation, and low Spetzler-Martin grade were significantly correlated with complete obliteration.

Conclusions:

• Ante-grade drifting Onyx injection is a safe and effective method for plexiform AVM embolization, reducing bleeding complications and increasing obliteration rates.
• Younger patient age, hemorrhagic presentation, and low Spetzler-Martin grade are favorable predictors for complete AVM obliteration.
• Further research may clarify the correlation between pretreatment mRS and perforation complications.