Diagnostic Imaging Department, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, 04024-002, São Paulo, SP, Brazil.
Interventional Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise-Paré, 75010, Paris, France.
Clin Neuroradiol. 2018 Dec;28(4):579-584. doi: 10.1007/s00062-017-0615-7. Epub 2017 Aug 11.
To analyze the angiographic and clinical results of transarterial embolization with Onyx (Medtronic-Covidien, Irvine, CA) in dural arteriovenous fistulas (DAVFs) partially fed by arteries arising from the carotid siphon or the vertebral arteries.
We isolated 40 DAVFs supplied by either the tentorial artery of the internal carotid artery (ICA) or the posterior meningeal artery of the vertebral artery. These DAVFs were embolized with Onyx through the middle meningeal artery or the occipital artery. We reviewed the occurrence of reflux into the arteries of carotid or vertebral origin.
In all the cases, reflux occurred into the first millimeters of the DAVF arterial feeders arising from carotid or vertebral arteries but slowly enough to be controlled by interruption of Onyx injection. Reflux was always minimal and Onyx never reached the ostium of the arteries. No cerebral ischemic complications occurred in our series.
The behavior of Onyx is clearly different from that of cyanoacrylate glue, resulting in superior control during injection. Reflux into arteries arising from the ICA or vertebral artery during DAVF treatment always carries a risk of unintentional non-target embolization of normal cerebral vasculature but Onyx appears to be safe in this situation.
分析经颈内动脉虹吸段或椎动脉分支动脉入路行 Onyx（美敦力-柯惠公司，欧文，加利福尼亚州）栓塞治疗硬脑膜动静脉瘘（DAVF）的血管造影和临床结果，这些瘘部分由起源于颈内动脉虹吸段或椎动脉的动脉供血。
我们共隔离了 40 例由颈内动脉岩骨段脑膜动脉或椎动脉脑膜后动脉供血的 DAVF。通过脑膜中动脉或枕动脉将 Onyx 栓塞至这些 DAVF。我们回顾了动脉反流至颈内或椎动脉起源的情况。
在所有病例中，均出现了 Onyx 反流至起源于颈内或椎动脉的 DAVF 动脉供血支的前几毫米处，但反流速度足够慢，通过中断 Onyx 注射即可控制。反流始终是轻微的，Onyx 从未到达动脉的开口。本系列中无脑缺血性并发症发生。
Onyx 的行为明显不同于氰基丙烯酸酯胶，在注射过程中具有更好的控制性。在治疗 DAVF 时，若出现起源于颈内动脉或椎动脉的动脉反流，始终存在意外栓塞正常脑血管的风险，但在这种情况下，Onyx 似乎是安全的。
