J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):144-153. 10.7461/jcen.2022.E2021.12.003.

Comparison of transarterial n-BCA and Onyx embolization of brain arteriovenous malformations: A single-center 18-year retrospective analysis

• Behzadi F
• Heiferman DM
• Wozniak A
• Africk B
• Ballard M
• Chazaro J
• Zsigray B
• Reynolds M
• Anderson DE
• Serrone JC

• KMID: 2531657
• DOI: http://doi.org/10.7461/jcen.2022.E2021.12.003

Abstract

Objective
Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted.
Methods
We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx.
Results
Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort.
Conclusions
In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.

Keyword

Arteriovenous malformation; Embolization; n-butyl cyanacrylate (n-BCA); Ethylene vinyl alcohol copolymer; Onyx

Figure

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  Fig. 1. Bar plot demonstrating the distribution of embolization sessions based on percent devascularization, in 25% increment bins, for n-BCA and Onyx groups. n-BCA, n-butyl cyanoacrylate

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  Fig. 2. Boxplot graph comparing the percent devascularization per pedicle between n-BCA and Onyx. n-BCA, n-butyl cyanoacrylate

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  Fig. 3. Demonstrating the correlation of percent devascularization to the initial volume of the AVM in both the n-BCA and the Onyx groups. AVM, arteriovenous malformations; n-BCA, n-butyl cyanoacrylate

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  Fig. 4. Demonstrating the correlation of percent devascularization and the number of AVM pedicles embolized in the n-BCA and Onyx groups. AVM, arteriovenous malformations; n-BCA, n-butyl cyanoacrylate

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  Fig. 5. Ruptured right parietal AVM, pre-surgical Onyx embolization. A ruptured right parietal AVM with intercranial hemorrhage and brain swelling requiring a decompressive hemicraniectomy (A). A pre-embolization right internal carotid artery angiogram with AP (B) and lateral (C) views show AVM dimensions of 1.9 cm×1.8 cm×1.1 cm with a calculated volume of 1.89 mL. Microcatheter angiography showing nidus and draining vein from the first MCA branch before onyx injection (D). Lateral right internal carotid angiogram after 1 MCA pedicle embolization showing 28% volume reduction (E). A second MCA feeding artery microcatheter angiogram with nidus and draining vein (F). The objective of this embolization was adjuvant pre-surgical. Final lateral right internal carotid artery angiogram shows a 94% volume embolization with delayed filling of the 2 embolized MCA pedicles (G) and delayed filling of the draining vein (white arrow) (H). AVM, arteriovenous malformations; AP, anteroposterior; MCA, middle cerebral artery

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