Evaluating the Potential of Preembolization Using Ethylene-Vinyl Alcohol (Onyx and Squid) in Carotid Body Tumor
Lucca B Palavani1, Raphael Camerotte2, Lucas Pari Mitre3
1Faculty of Medicine, Max Planck University Center, São Paulo, Brazil.
Objective:
This study aims to evaluate the efficacy and safety of preoperative embolization, used 48 hours before surgery to reduce tumor size and surgical complications in carotid body paragangliomas.
Methods:
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Cochrane Handbook. A comprehensive literature search was performed in Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were: 1) observational studies, 2) reporting on diagnosed carotid body paragangliomas, 3) undergoing preoperative embolization procedures, and 4) with ethylene-vinyl alcohol as an embolic agent.
Results:
The study analyzed 106 patients, aged 18-79, using primarily Onyx 18 for embolization, with treatment intervals ranging from 24 hours to 2 weeks. Efficacy outcomes showed near-total devascularization in 67% of cases (95% confidence interval [CI]: 0.47-0.87; I² = 74%), subtotal devascularization in 33% (95% CI: 0.12-0.54; I² = 43%), and total devascularization in 97% (95% CI: 0.88-1.00; I² = 41%), indicating significant heterogeneity across outcomes. The mean estimated blood loss was 184.46 ml (95% CI: 116.72-252.20 ml). Postembolization complication rate was exceptionally low at 1% (95% CI: 0.00-0.06; I² = 0%).
Conclusions:
In conclusion, preoperative embolization of carotid body tumors achieved high rates of devascularization with minimal blood loss and a very low incidence of complications, highlighting its effectiveness and safety as a treatment strategy.
