PT  - JOURNAL ARTICLE
AU  - D.G. Abud
AU  - R. Riva
AU  - G.S. Nakiri
AU  - F. Padovani
AU  - M. Khawaldeh
AU  - C. Mounayer
TI  - Treatment of Brain Arteriovenous Malformations by Double Arterial Catheterization with Simultaneous Injection of Onyx: Retrospective Series of 17 Patients
AID  - 10.3174/ajnr.A2247
DP  - 2011 Jan 01
TA  - American Journal of Neuroradiology
PG  - 152--158
VI  - 32
IP  - 1
4099  - http://www.ajnr.org/content/32/1/152.short
4100  - http://www.ajnr.org/content/32/1/152.full
SO  - Am. J. Neuroradiol.2011 Jan 01; 32
AB  - BACKGROUND AND PURPOSE: The use of Onyx in the treatment of intracranial AVMs has increased the cure rate of endovascular embolization compared with the use of liquid adhesive agents. Inadvertent occlusion of the draining veins before the complete exclusion of the nidus constitutes a major risk of bleeding. We report a case series using the technique of double simultaneous arterial catheterization as an approach to achieve the complete exclusion of the nidus before reaching the venous drainage, through a more controlled hemodynamic filling. MATERIALS AND METHODS: Between April 2008 and November 2009, 17 patients with brain AVMs were treated by the DACT. The mean age of the patients was 32.7 years (range, 6–54 years), with 9 females and 8 males. The clinical onset was characterized by intracranial hemorrhage in 8 patients and by seizures in 7. The size of the AVMs ranged from 13 to 54 mm (average, 26.2 mm). The DACT was always used with the objective of curing the AVM. RESULTS: All 17 patients completed the EVT. The average number of sessions conducted was 1.4 (range, 1–3 sessions), with the average injection amount of 6.9 mL of Onyx (range, 2–25.2 mL). Sixteen AVMs (94.1%) were angiographically cured by embolization. Clinical complications occurred in 2 patients (11.7%); 1 of these was permanent (5.9%). No deaths were registered. CONCLUSIONS: This preliminary series shows that the DACT presents satisfactory results when used with curative intent. ACAanterior cerebral arteryAVMarteriovenous malformationDACTdouble arterial catheterization techniqueDMSOdimethyl-sulfoxideDSAdigital subtraction angiographyECAexternal carotid arteryEVDexternal ventricular derivationEVTendovascular treatmentICAinternal carotid arteryMCAmiddle cerebral arteryMMAmiddle meningeal arterymRSmodified Rankin Scalen-BCAn-butyl cyanoacrylate