Division of Interventional Neuroradiology, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Avenida Bandeirantes, 3900 Monte Alegre, Brazil.
J Neuroradiol. 2013 Mar;40(1):45-9. doi: 10.1016/j.neurad.2012.03.010. Epub 2012 May 24.
Since the introduction of Onyx as a liquid embolic agent for the treatment of brain arteriovenous malformation (AVM), higher endovascular cure rates have been achieved. This may be partially attributed to its non-adhesive property, which allows longer intranidal progression of the embolic agent before solidification. However, Onyx reflux around the microcatheter can form a highly viscous plug, thereby constraining the microcatheter during its retrieval. Also, during the maneuver, arterial stretching can lead to vascular rupture and result in acute bleeding, a potentially fatal complication that demands immediate treatment. This report describes a new treatment strategy for the rapid management of such a complication. The technique consists of the placement of a second microcatheter about 2 cm proximal to the AVM nidus in the same artery containing the intranidal microcatheter. After conclusion of embolization, if rupture occurs during intranidal microcatheter retrieval, the second microcatheter that is already in place can promptly be used to control the bleeding.
自 Onyx 作为一种用于治疗脑动静脉畸形（AVM）的液体栓塞剂引入以来，已经实现了更高的血管内治疗成功率。这可能部分归因于其非粘性特性，这使得栓塞剂在凝固前可以在瘤腔内更长时间地推进。然而，Onyx 会回流到微导管周围，形成高度粘稠的塞子，从而在取出微导管时对其产生限制。此外，在操作过程中，动脉拉伸可能导致血管破裂并导致急性出血，这是一种潜在致命的并发症，需要立即治疗。本报告描述了一种快速处理此类并发症的新治疗策略。该技术包括在含有瘤内微导管的同一动脉中，将第二根微导管放置在距 AVM 病灶近端约 2 厘米处。如果在瘤内微导管取出过程中发生破裂，在栓塞完成后，已经放置到位的第二根微导管可以迅速用于控制出血。
