Durst Christopher R, Starke Robert M, Gaughen John, Evans Avery J
Department of Radiology and Medical Imaging, University of Virginia, P.O. Box 800170, Charlottesville, VA 22901, USA.
Department Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
J Clin Neurosci. 2015 Feb;22(2):391-5. doi: 10.1016/j.jocn.2014.07.030. Epub 2014 Oct 30.
Historically, the endovascular treatment of arteriovenous malformations (AVM) has largely been relegated to an adjunctive role to open surgical and radiosurgical methods. In this article, we describe a novel endovascular approach to the treatment of brain AVM using Onyx (ev3 Endovascular, Plymouth, MN, USA), which may allow for a complete angiographic obliteration in a single treatment session. Twelve patients underwent Onyx embolization of an AVM using a novel "reverse plug and push" technique in which a plug is formed around the treatment catheter prior to injecting Onyx into the AVM. The plug mitigates the risk of backflow and catheter entrapment, thereby allowing the user to inject higher volumes of Onyx at higher injection rates. Patient demographics, AVM characteristics, and treatment details were reviewed. Using the "reverse plug then push" technique, an average of 8.8 mL of Onyx was injected into the AVM in a single session. In every case, the microcatheter was removed easily with minimal traction pressure. Complete angiographic obliteration was achieved in 83% of patients after a single treatment. Morbidity and mortality were 8% each. The "reverse plug then push" technique allows for a more rapid injection of Onyx due to the formation of a well-controlled plug prior to treatment, mitigating the risk of catheter entrapment by Onyx reflux. With further refinement, this technique may present a viable curative option for treatment of select brain AVM.
从历史上看，动静脉畸形（AVM）的血管内治疗在很大程度上一直被视为开放手术和放射外科方法的辅助手段。在本文中，我们描述了一种使用Onyx（美国明尼苏达州普利茅斯市ev3血管内公司生产）治疗脑AVM的新型血管内方法，该方法可能允许在单次治疗中实现血管造影完全闭塞。12例患者采用一种新型的“反向栓塞推注”技术进行了AVM的Onyx栓塞，即在将Onyx注入AVM之前，围绕治疗导管形成一个栓塞。该栓塞可降低反流和导管嵌入的风险，从而允许使用者以更高的注射速率注入更大体积的Onyx。回顾了患者的人口统计学特征、AVM特点和治疗细节。采用“反向栓塞然后推注”技术，单次治疗中平均向AVM注入8.8 mL的Onyx。在每种情况下，微导管都能在最小牵引压力下轻松取出。单次治疗后，83%的患者实现了血管造影完全闭塞。发病率和死亡率均为8%。“反向栓塞然后推注”技术由于在治疗前形成了良好控制的栓塞，允许更快地注入Onyx，降低了Onyx反流导致导管嵌入的风险。随着进一步完善，该技术可能为治疗特定的脑AVM提供一种可行的治愈选择。
